Placement of a ureteral stent (JJ) after ureterorenoscopy (URS) procedures is a common practice in urology. Unfortunately, these double pigtails stents are responsible for significant postoperative morbidity. However, the effect of URS on sexual function in young men has not been studied well to date. We aimed to evaluate the possible effects of ureteroscopic stone surgery procedures with versus without postoperative ureteral stenting on the male the sexual behavior.
In a randomized prospective and controlled study conducted between December 2014 and August 2016, we enrolled 91 young men from three university urology department, and they underwent uncomplicated ureteroscopy for ureteral distal calcul. They were randomly divided in three groups: the first one (G1) contained 31 patients who underwent uretersocopy with ureteral double J stent for one month, the second group (GII) with 32 cases treated by URS followed by shorter ureteral cathéterization. Patients affected by risk factors for erectile dysfunction or hormonal and metabolic alterations were excluded.Sexual function has been evaluated in detail by using the five IIEF domains [Erectile function (EF), intercourse satisfaction (IS), orgasmic function (OF), sexual desire (SD) and overall satisfaction (OS) completed one day before URS, one month after the procedure and eight weeks after stent withdrawal. The secondary outcomes were the assessment of effects of operative time, LUTS, quality of life, educational status and psychogenic characteristics on sexual function. For all statistical tests, a p value was fixed at 0.05.
The preoperative demographic chracteristics were comparable between three groups. If we compare Preoperative versus postoperative IIEF score, we noted a significant reduction in the erectile function (IIEF-EF) and intercourse satisfaction (IIEF-IS) in the GI compared to GII and GIII at one and two months postoperatively (p =0.000). Erectile failure was significantly correlated to pathological IPSS score (P=0.001) anxiety and flank pain (respectively p=0.000, p=0.014, p=0.02). The stent size (diameter and length) was not significantly related to sexual impairment. The preoperative demographic characteristics were comparable between three groups: Mean patient age, mean Body Mass Index (BMI), level of education, mean Beck depression score, mean IPSS, size and location of ureteral calculi.
According to our results, ureteral stents can severely impair global quality of life and the quality of sexual health in younger male, particularly the erectile function. However, it is clear that further prospective studies with large population of cases are certainly needed in order to outline this unresolved but important subject.