Ureteroscopy may adversely affect erectile function

Results of a retrospective study raise concern that ureteroscopy may adversely affect erectile function.

The research, which was reported at the 2016 World Congress of Endourology in Cape Town, South Africa by urologists from the University of South Florida, Tampa, analyzed change in Sexual Health Inventory for Men (SHIM) severity grade for 38 men who had pre- and post-ureteroscopy data. Twenty-one men (55%) had no ED pre-ureteroscopy (SHIM 22-25), five men had mild ED (SHIM 17-21), mild-moderate (SHIM 12-16) and moderate ED (SHIM 17-21) were each present in two men, and eight men had severe ED (SHIM 22-25).

At a median follow-up of 37 days after ureterscopy, 16 men (42%) had a worsening of ED score, and half of those men had a worsening of ED grade. ED grade worsening occurred among five men with no ED pre-ureteroscopy (24%; p=.03), two men who had mild ED (40%; p=.40), and one man with moderate ED (50%; p=.422).

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“To our knowledge, this is the first study to investigate whether ureteroscopy may affect erectile function. We were somewhat surprised by the findings considering that we could not find anything else published on this topic, and we recognize that our retrospective study has limitations,” said Bhavik B. Shah, MD, urology resident at the University of South Florida.

“However, further investigation is warranted to determine if the risk is real because it would be important information for counseling men who are deciding on surgical treatment for nephrolithiasis,” added Dr. Shah, who worked on the study with Rafael Carrion, MD, and colleagues.

The authors became interested in exploring an association between ureteroscopy and ED when it was observed anecdotally that men were complaining about new-onset ED at a post-ureteroscopy follow-up visit.

“At first we thought the temporal association was just coincidental, but as the number of these men increased, we thought it was worth seeing if we could find data to corroborate our clinical impression,” Dr. Shah said.

Patients who present to the University of South Florida stone clinic are asked to complete the SHIM. The 38 men who had pre- and post-ureteroscopy SHIM scores were identified from a total group of 100 men who underwent ureteroscopy between October 2011 and July 2015.

Next: Limitations include small sample size

Limitations include small sample size

“Certainly there is the potential for some selection bias in our study, and perhaps men who develop new-onset ED are more likely to complete the post-ureteroscopy SHIM questionnaire,” Dr. Shah said.

Small sample size is another limitation of the study and would account for why the percentages of men with worsening of ED grade among those with mild and moderate ED initially did not achieve statistical significance.

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Now, the investigators hope to gather additional data from more men who undergo ureteroscopy. They would also like to collect serial follow-up data to investigate the longevity of a possible effect of ureteroscopy on ED.

In addition, if they find uretersocopy does affect erectile function, they would like to determine the cause. Dr. Shah proposed several mechanisms, including injury to the dorsal nerves supplying the penis from mechanical trauma or the anesthesia, stent placement, or a post-surgery psychological phenomenon.