Ejaculatory function after anastomotic urethroplasty for pelvic fracture urethral injuries

The effect of anastomotic urethroplasty for pelvic fracture urethral injuries (PFUIs) on ejaculatory profile is under-reported in the literature. There is controversy as regards the effect of bulbocavernous muscle splitting during surgery on ejaculatory function (EjF). We evaluated the effects of anastomotic urethroplasty on EjF using a validated questionnaire.

We retrospectively reviewed the computerized surgical records to identify patients who underwent anastomotic posterior urethroplasty for PFUIs from June 1998 to January 2014. Those patients were retrieved and evaluated for their EjF using the EjF component of the Male Sexual Health Questionnaire (MSHQ).

Overall, 58 patients were included in the study with a mean age of 31.6 years. All patients except one have antegrade ejaculation, and according to the overall ejaculatory score, only 5 patients (8.6%) reported ejaculatory dysfunction and the remaining 53 (91.4%) had good or average EjF. Ten men (17.2%) reported decreased volume and force of ejaculate. Decreased pleasure during ejaculation was the commonest ejaculatory disorder (39.6%). The score of each of the seven ejaculatory questions among the study patients was in harmony to the previous study of anterior urethroplasty except that men in this study had higher ejaculatory frequency and latency.

Nearly all men maintained antegrade ejaculation after posterior urethroplasty for PFUIs. The risk of urethral reconstruction and splitting the bulbocavernous muscle on ejaculation seems to be minimal.