Ejaculatory profiles and fertility in men after posterior urethroplasty for pelvic fracture‐urethral distraction defect injuries

Abstract

PATIENTS AND METHODSWith institutional review board approval, patients who had PFUDD repairs by one surgeon from 1990 to 2004 were identified from a database. Patients were contacted and given a questionnaire eliciting details about their ejaculatory function and history of fertility. Those interested in future paternity were asked to provide semen for analysis. RESULTSIn all, 32 men were contacted; all claimed to have antegrade ejaculation, although five reported having a lower ejaculatory volume than before their injury, and one claimed that his ejaculate was delayed. We assessed fertility in 19 men, six of whom had either infertility or abnormal semen analyses. CONCLUSIONSAll men in the present series who had PFUDD injuries repaired had antegrade ejaculation. Although six of 19 had either infertility or an abnormal semen analysis, it appears that the risk of damage to the ejaculatory ducts from either a PFUDD or the subsequent urethral reconstruction is low. However, other associated injuries at the time of the pelvic fracture might place these men at greater risk of infertility. KEYWORDSposterior urethroplasty, male urethral stricture, infertility, semen analysis, ejaculation Study Type -Therapy (outcomes research) Level of Evidence 2c OBJECTIVEIn men who sustain a pelvic fractureurethral distraction defect (PFUDD) injury, repairing the urethra involves a complicated urethral anastomosis located posteriorly at the junction of the membranous and prostatic urethra. In this study we performed a postoperative semen analysis and questionnaire study to determine the effect of PFUDD injuries and PFUDD repair on ejaculatory function and fertility in these men.

Urethral trauma. Part II: Types of injury and their management

“…However, '20% to 84% of patients with PFUI have ED' this is unusual. Most patients retain all aspects of sexual function although ejaculation may be weaker and fertility reduced particularly in older patients [108]. A confounding issue, rarely discussed, is a complaint of ED in a patient seeking compensation for his injury or surgery.…”

Sexual (Dys)function after Urethroplasty

“…Table 6 summarizes the studies that address the impact of various types of urethroplasty in ejaculatory function [ 3 , 27 , 32 , 33 , 61 – 63 ]. Although most of the studies are retrospective and merely assessed the presence of anterograde ejaculation, most used validated instruments, ejaculatory domains of MSHQ or BMFSI.…”

“…There are some specific articles that address fertility in the context of urethroplasty ( Table 8 ) [ 52 , 63 , 65 ]. These studies essentially describe the seminal parameters of patients having undergone posterior urethroplasty.…”

Delayed repair is the ideal management for posterior urethral injuries- For the motion

“…Anger et al . [21] have found the ejaculatory profiles and fertility in men after posterior urethroplasty for pelvic fracture-urethral distraction defect injuries to be within normal limits in their review which clearly shows the advantage of delayed management over early intervention.…”