The effect of urethroplasty surgery on erectile and orgasmic functions: a prospective study. Ozgur H. Yuksel 2. Metin I. Ozturk 1.
Urethroplasty was applied for bulbar and penile urethral strictures. These microphones are separated by a baffle that rests against the dysfunctioj lip Fig. Oral sound. Urol Clin North Am. It was stated that the time required for complete recovery of erectile function after surgery in patients Kelligirl bbw 40 years is 6 months
Sex horoscope aquarius and libra. Introduction
The etiology of urethral stricture disease is multifactorial and includes trauma, inflammatory, and iatrogenic causes. Cranial Bulgar IX and X are responsible for swallowing and esophageal motility. Rosen R. Accordingly, there was a significant improvement in IPSS after 6 weeks and 6 months overall and in both groups Table 2 ; Figure 2 a. The urethral catheter is maintained for 14 days and Bulbar sexual dysfunction voiding cystourethrogram is made upon removal. Inflammatory conditions like Guillain-Barre syndrome is also one of the causes of Bulbar Palsy. Bulbar palsy refers to a range of different signs and symptoms linked to impairment of function of the cranial nerves 9, 10, dysunction, 12, which occurs due to a lower motor neuron lesion in the medulla oblongata or from lesions of the lower cranial nerves outside the brainstem. Synonyms: 'bulbar palsy' - lower motor neurone dysarthria, neuromuscular dysarthria, atrophic bulbar paralysis; 'pseudobulbar palsy' - upper motor neurone dysarthria, spastic dysarthria. The effect of bulbar urethroplasty on erectile function. An early recognition Tiny teens skinny dipping this genotype can prevent death in a condition, which is easily treatable with a good long-term outcome. Use the link below to share a full-text Bulbar sexual dysfunction of this article with your friends and colleagues. Keywords: Cholinergic receptor, nicotinic, and epsilon, Bhlbar phenotype, congenital myasthenic syndromes, dysfunctionn protein of the synapse, stridor.
- Bulbar Palsy also known as Progressive Bulbar Palsy is a pathological condition in which the nerve cells which are responsible for movement get affected.
- Congenital myasthenic syndromes are a group of rare genetic disorders affecting neuromuscular transmission.
- Bulbar palsy refers to a range of different signs and symptoms linked to impairment of function of the cranial nerves 9, 10, 11, 12, which occurs due to a lower motor neuron lesion in the medulla oblongata or from lesions of the lower cranial nerves outside the brainstem.
- To evaluate alterations in sexual function and genital sensitivity after anastomotic repair AR and free graft urethroplasty FGU for bulbar urethral strictures.
- Wayne J.
- Professional Reference articles are designed for health professionals to use.
The effect of urethroplasty surgery on erectile and orgasmic functions: a prospective study. Ozgur H. Yuksel 2. Metin I. Ozturk 1. The prospective study was conducted between January and August with 60 cases. Before the urethroplasty operation and postoperative 6th month follow-up, the international index of erectile function IIEF form 15 questions , was filled, the relevant domains of sexual function; erectile function Q1,2,3,4,5,15 , orgasmic function Q9,10 and overall satisfaction Q13,14 were assessed.
However, preoperative IIEF, sexual satisfaction and orgasmic function averages of patients with a stenosis segment length of cm was found to be significantly higher than that of patients with a stenosis segment length of cm. Between stenosis segment length groups, there was no statistical difference in terms of preoperative and postoperative sexual functions. However, there were statistically significant change in the postoperative IIEF and sexual satisfaction averages according to preoperative averages.
Our study suggests that urethroplasty surgery itself does not significantly affect erectile function, orgasmic function, and general sexual satisfaction regardless of the type of surgery, localization and length of stenosis. Besides, there was a significant decrease in erectile function in senior adults.
Urethral stricture refers to the scar formation involving the spongiformis erectile tissue of the corpus spongiosum, resulting in a concomitant narrowing of the urethral lumen. The process leading to this fibrosis is primarily subepithelial inflammation and hemorrhage and later stages are characterized with sclerosis and fibrosis.
Posterior urethral injuries are often associated with pelvic fractures. Treatment alternatives include; dilatation, internal urethrotomy, laser treatments, and open reconstruction. In the past, known as the reconstructive ladder, it has always been suggested that the simplest procedure should always be tried in the first stage, and in case of failure, proceeding to more complex approaches is recommended in guidelines.
In modern urethral reconstruction, this approach is considered outdated. Even in some studies it has been shown that recurrent dilatations and internal urethrotomies reduce the success rate of ultimate open urethral reconstruction 1 , 2. Certainly there are also strictures that require tissue transfer; grafts and flaps are successfully deployed here 3 , 4.
In addition to psychogenic factors, erectile dysfunction ED after urethroplasty may be due to damage to the cavernous nerve, damage to the perineal nerve, and deterioration of the flow of the bulbar artery. In order to reduce this damage, it is suggested to protect bulbospongiosus muscle and peroneal nerves, not to cut central tendon, not to damage the bulbar artery, use buccal mucosal graft without cutting corpus spongiosum 5 — 7.
The neurovascular structures responsible for the erectile function pass from a distance of approximately 3 mm from clockwise 1 and 11 right outside the corpus spongiosum and some branches from the cavernous nerves enter the corpus spongiosum across the entire penis.
The intercranial area shows that this vessel and nerve bundle is unprotected and vulnerable to trauma. For this reason, the bulb can be very easily damaged during the dissection of the urethra 8 — Another important point for this region is the damage of the perineal nerve during the separation of the bulbospongiosus muscle on the corpus spongiosum. It provides semen expulsion and sense of penile ventral surface In addition to the effect of the perineal nerve on ejaculation, there is also an effect on erectile function.
For this reason, the perineal nerve is thought to be an extra neural pathway for erectile function through unrecognized reflex mechanisms. To protect erectile functions after urethroplasty, it would be beneficial to preserve this neural tissue, if possible 12 , In this study, we examined the effects of urethroplasty surgery on sexual functions by taking into account age, location of stenosis, length of stenosis and surgical technique parameters and we hypothesized that location and length of stricture and type of urethroplasty is not affecting sexual functions but older age may affect postoperative sexual functions.
Following ethical board approval, the prospective study was conducted between January and August with 60 cases aged between 19 and 75 years. And also, patients with a history of coronary artery bypass graft surgery, unregulated hypertension and diabetes were excluded from the study.
Only six patients with 2 cm stricture at bulbar urethra, had undergone endoscopic intervention once before and failed.
All urethroplasty operations were performed by the same surgeon experienced in reconstructive urology. All patients were evaluated with anamnesis, history, physical examination, urine analysis and culture, uroflowmetry, retrograde urethrography before surgery.
Before the open urethroplasty operation and postoperative 6th month follow-up, the international index of erectile function IIEF form 15 questions was filled, the relevant domains of sexual function; erectile function Q, 15 , orgasmic function Q9, 10 and overall satisfaction Q13, 14 were assessed.
The technique of the surgery, localization of the stricture and the length of the narrow segment were also noted. Urethroplasty was applied for bulbar and penile urethral strictures. This series includes excision and end - to - end anastomoses using both transecting and non - transecting technique , dorsal onlay buccal mucosal graft, ventral inlay buccal mucosal graft and penile skin flap cases.
During operation, surgeon prone to keep the dissection area as small as possible at the bulbar urethral level and did not used cautery during the dissection.
And also, surgeon tried to protect bulbospongiosus muscle and peroneal nerves, not to cut central tendon, not to damage the bulbar artery, and used buccal mucosal graft without cutting corpus spongiosum. When the study data were evaluated, the normal distribution of the parameters was assessed by the Shapiro Wilks test. When study data were evaluated; Kruskal Wallis test was used in comparing quantitative data for comparison of parameters without normal distribution as well as descriptive statistical methods mean, standard deviation, frequency.
Student's t test was used to compare parameters with normal distribution between two groups and Mann Whitney U test was used to compare parameters without normal distribution between two groups. Paired Sample t test was used for intra - group comparison of quantitative data showing normal distribution, Wilcoxon Signed Ranks test was used for intra - group comparison of parameters without normal distribution. The prospective study was conducted between January and August with 60 cases aged between 19 and 75 years.
The mean age of the cases was The stricture segment lengths ranged from 2 to 7 cm, with a mean of 3. In Preoperative IIEF values of the patients ranged from 8 to 29, with a mean of Preoperative IIEF, sexual satisfaction and orgasmic function averages of patients with a stricture segment length of cm was found to be significantly higher than that of patients with a stricture segment length of cm p: 0.
According to age groups, preoperative sexual satisfaction averages of those aged 65 and below were statistically significantly higher than those of older than 65 years p: 0. However, there were no statistically significant difference in the mean preoperative IIEF and orgasmic function p: 0. Again, postoperative IIEF, sexual satisfaction and orgasmic function averages of those aged 65 and below were found to be statistically significantly higher than those of those older than 65 years p: 0.
However, there were statistically significant change in the postoperative IIEF and sexual satisfaction averages according to preoperative averages p: 0. Sexual dysfunction after urethroplasty is a very broad definition that also includes disorders of erectile dysfunction, ejaculatory disorders, penile curvature or chordee and genital sensitivity disorders. In some studies it was thought that the age of the patient, pre - surgical sexual function, previous surgical intervention, post - operative survival, length of stenosis and severity of stricture might be factors affecting long - term erectile function after urethroplasty 14 — The first article on continuous ED development after urethroplasty was written by Mundy et al.
The relationship between ED after the urethroplasty and the patient's age was different in different studies. A study by Johannes and his colleagues found that the ED frequency decreased as the age of the patients decreased. In another study, it was shown that patient age is important in improving ED after urethroplasty.
It was stated that the time required for complete recovery of erectile function after surgery in patients under 40 years is 6 months In a prospective study conducted by Erickson et al. They stated that bulbar urethroplasty can affect erectile function more than penile urethroplasty and this can be explained with the fact that bulbar urethra is located closer to the nerve responsible for the erection Haines et al.
This relationship has also been explained by reduced tissue plasticity, poor recovery, or perhaps even more co - morbidity of the elderly cohort, and thus greater susceptibility to ED development There are studies that show that age has a little effect on urinary and sexual functions after urethroplasty as opposed to these In our study, patients were evaluated in two different groups including patients younger than 65 years of age and patients older than 65 years of age.
In patients younger than 65 years of age, there was no statistically significant difference in terms of preoperative and postoperative sexual functions.
However, in patients older than 65 years of age, there were statistically significant difference in the postoperative IIEF and sexual satisfaction averages according to preoperative averages. In addition, while there was no significant difference between age groups in terms of preoperative IIEF and orgasmic functions, there was a statistically significant difference between the two groups in the postoperative averages. Although we cannot make an optimal assessment because of the small number of patients in this group of older than 65 years, these results suggest that the senior adult group may be more affected by urethroplasty surgery in terms of sexual functions.
When studies were examined, the type of urethroplasty applied was thought to be effective in the formation of ED.
In a study involving eighty - nine patients, patients were divided into 3 groups according to urethroplasty. Penile substitution urethroplasty, bulbar excision - anastomosis and bulbar substitution urethroplasty were compared. Average follow-up time was 15 months.
Stricture length and patient age were statistically similar in all groups. The authors noted that the type of urethroplasty applied did not have a significant effect on the development of ED and that erectile function after urethroplasty was improved within the first 6 months.
The same authors also recommended early use of phosphodiesterase type — 5 inhibitors and nonsteroidal anti-inflammatory drugs In the literature review of Dogra et al. Along with similar studies in the literature, Haines et al. In our study, there was no statistically significant difference for preoperative and postoperative IIEF scores, orgasmic function and sexual satisfaction according to stenosis localization and surgery type.
Initially, de novo ED after urethroplasty was shown to be higher in elderly patients and those with long stricture segments 6. Further work, however, has disproved this relationship. And in a recent meta - analysis, no relationship was found between the length of stricture and the incidence of postoperative ED 6 , According to Coursey et al.
In our study, although the preoperative erectile function of the patients with the long stricture segment was lower than the patients with the short stricture segment cm , there was no significant change in the erectile function of these patients in the postoperative period.
Erickson et al. However, older men reported that they had more ED after the surgery than younger men, but that erectile function probably improved over time In our study, in terms of preoperative IIEF, orgasmic function and sexual satisfaction, there were statistically significant differences between the stricture length groups of cm and cm.
Also, there were significant differences both preoperative and postoperative scores between the age groups of below and above The length of the urethral stricture is closely related to the grade of fibrosis in the urethra and surrounding tissues. Among the causes of long urethral strictures it is included inflammatory diseases, recurrent urethral dilatations, long - term urethral catheterizations, and traumatic urethral injuries.
In the literature review of Palminteri et al. Our study includes some limitations although it has a prospective design. A single surgeon in a single center conducted all of the urethroplasties. But it is acceptable to consider that surgical techniques and stricture etiology may significantly affect to the outcomes. Consequently, this may limit the generalizability of our results.
Erectile function, sexual drive, and ejaculatory function after reconstructive surgery for anterior urethral stricture disease. Patient Recruitment Out of male patients who underwent urethroplasty between October and February , 90 patients with a bulbar stricture only were planned to be treated with AR or FGU and eligible to participate in this prospective study. Duplex ultrasound peak systolic velocity of the cavernosal arteries increased from baseline by From Wikipedia, the free encyclopedia. It is postulated that this occurs from trauma itself, before urethroplasty is performed. Health Tools Feeling unwell?
Bulbar sexual dysfunction. 1. Introduction
N ormal pressure hydrocephalus NPH is a syndrome characterized by gait disturbance, cognitive impairment, and urinary incontinence, as well as enlargement of the ventricles, which results from disturbance of CSF circulation in a setting of normal CSF pressure.
Secondary NPH occurs after trauma, subarachnoid hemorrhage, meningitis, or intracranial surgery, and the idiopathic form is characterized by no known causative disorders. The pathogenesis of NPH remains uncertain, although several hypotheses have been proposed.
Suggested mechanisms responsible for the associated clinical symptoms include reduction in blood flow and metabolism, and altered neuronal conduction due to stretching of periventricular white matter PVWM. Many other symptoms have been reported, including subsequent apathy, anxiety, depression, 34 , 39 , 43 impaired wakefulness, 7 , 24 and sexual dysfunction, 31 but on our review of the literature, no previous studies have investigated and reported on bulbar dysfunction in NPH.
We observed that several patients with a history of frequent choking had been admitted to the intensive care unit because of aspiration pneumonia before a diagnosis of NPH was made. Soon after shunt placement surgery, these patients had no further episodes of aspiration or choking. Moreover, these patients experienced hoarseness or hypophonia, which is usually concomitant with some degree of aspiration.
The cessation or reduction in severity of aspiration also occurs after the CSF tap test. These symptoms may be explained by a stretching of PVWM. An enlarged ventricle can affect corticospinal integrity, thereby causing gait disturbance in a patient with NPH.
The primary objective of this study was to compare preoperative and postoperative prevalence of bulbar dysfunction in patients with NPH. Secondary objectives included assessing the results of surgery for swallowing, speech, gait, cognition, and urination, and evaluating the correlation between bulbar dysfunction and triad symptoms.
Candidates for our study were patients with probable NPH. The following inclusion and exclusion criteria were adopted. The inclusion criteria all required were as follows: 1 patients with more than 1 of the following symptoms: gait disturbance, cognitive impairment, and urinary incontinence; 2 patients with clinical symptoms that could not be completely explained by other diseases; 3 patients with ventricular dilation documented by CT or MRI; and 4 patients with CSF pressure lower than 20 cm H 2 O with normal CSF cell count.
The exclusion criteria at least 1 required were: 1 patients with diseases or medical conditions of the head and neck region that could cause swallowing and speech problems e. Patients who met all of the above inclusion criteria were enrolled. Enrolled participants then underwent shunt placement surgery with a ventriculoperitoneal shunt VPS or lumboperitoneal shunt LPS , depending upon surgeon and patient preference. Enrolled participants were evaluated before shunting and at 1, 3, and 6 months after surgery.
The initial pressure for the shunt system was set after surgery. Valve pressure was readjusted at postoperative intervals, as required. Shunt function was assessed regularly, especially when there was no improvement in clinical symptoms.
The outcome measurements included: the number of steps and time seconds needed to walk 10 m at free speed; the Thai Mental State Examination TMSE ; 48 and an ordinal urinary incontinence scale, 8 in which the level of incontinence ranged from 1 to 6, with a higher score indicating a more incontinent condition.
Bulbar dysfunction was categorized into swallowing problems and speech problems. A swallowing problem was evaluated using the Swallowing Problem Questionnaire SPQ and a speech problem was evaluated using an articulation test, the volume and frequency of the voice, and resonance. Designed by Manochiopinig et al. The maximum score is 16, with a score of 0 indicating normal swallowing function. The patient or a relative was interviewed by a physician to facilitate the completion of the SPQ.
All patients were evaluated by a professional speech-language pathologist. The assessment consisted of 3 component parts. Articulation Test. Patients were tested using the Thai Articulation Test TAT , 26 , 27 , which consists of all Thai phonemes, including 21 initial consonants, 8 final consonants, 12 clusters, 24 vowels, and 5 tones in the Thai language. Patients pronounce a list of words aloud until the test is completed and articulation is determined to be normal or abnormal.
Volume and Frequency of Voice. Using normal-conversation voice volume, patients count from 1 to 10 into a microphone that is connected to a computer. The software then computes and analyzes voice volume dB and voice frequency Hz. The distance between the patient's mouth and the microphone was 6 inches. Patients performed this exercise 2 times, with the average of the 2 times recorded as the test result. Resonance is the speech quality that results from sound vibrations in the pharynx, oral cavity, and nasal cavity.
Normal resonance is highly dependent on normal velopharyngeal structures and function. Velopharyngeal structures include the velum, lateral pharyngeal walls, and posterior pharyngeal wall.
Hypernasality is a resonance disorder that results from velopharyngeal inadequacy VPI. Specifically, in patients with hypernasality, oral sounds inappropriately resonate into the nasal cavity due to inadequate closure of the velopharyngeal valve. The RST is composed of 3 short speech sentences and 2 examinations of velopharyngeal function. Each of the 5 items is rated as being either normal successful or abnormal unsuccessful. The maximum score is 5, with a score of 0 score indicating normal velopharyngeal function.
A nasometer —3, Kay Elemetrics Corp. This device consists of a headset that has directional microphones for the nose and mouth. These microphones are separated by a baffle that rests against the upper lip Fig. The microphones pick up acoustic energy from the nasal and oral cavities. The ratio of nasal to total nasal plus oral acoustic energy is then calculated.
Individuals with VPI were assumed as having hypernasality, which manifested as high nasalance scores. Patients were asked to read 3 standard passages from the Thai Nasality Test. The second passage is an oral passage that is devoid of nasal consonants.
The third passage is an oronasal passage that comprises a mix of oral and nasal consonants used in everyday conversation. Nasalance scores were compared with normative data of Thai subjects.
In the present study, only the oronasal passage was used to determine whether resonance was hypernasality or not. Comparisons between before and after shunt placement were performed using the Wilcoxon signed ranks test or McNemar's test. Correlations were analyzed using Spearman's rank correlation coefficient r s , Pearson's correlation coefficient r , or point-biserial correlation coefficient r p. There were 35 males and 18 females, with a mean age of Of 53 patients who underwent shunt surgery, 3 patients were lost to follow-up at the 6-month time point for the following reasons: 1 patient died due to upper airway obstruction, 1 patient developed pneumonia with sepsis, and 1 patient suffered a traumatic intracranial hematoma ICH; Fig.
Patient demographic data are shown in Table 3. Patient clinical data are given in Table 4. Fifty-two patients improved in at least 1 of 3 triad symptoms.
One patient was a nonresponder, having failed to improve in any of the 3 triad symptoms. The nonresponding patient also developed acute kidney injury at 1 month after shunt placement. Fifty patients received swallowing assessment at 6 months postoperatively. Three patients were lost to followup for the reasons described immediately above. The maximum SPQ score in our study population was 10 points out of a possible maximum of 16 points Fig. Distribution of change in swallowing problem severity score from preoperatively to 6 months postoperatively.
The numbers in the first row and first column represent the number of symptoms SPQ score. Clear cells indicate no change, light gray cells indicate improvement, and dark gray cells indicate deterioration. Forty-nine patients were given a speech assessment at 6 months after shunt placement. Three patients were lost to follow-up for the reasons mentioned above, 1 of whom developed an ICH due to coagulopathy.
The articulation of 28 patients remained abnormal postoperatively Table 3. No correlation was identified between loudness and triad symptoms.
Of the 37 patients with preoperatively abnormal RST scores, 11 became zero RST scores, 10 had a decreased RST score, 13 had no change, and 3 experienced deterioration in their condition at 6 months after shunt placement. Distribution of change in RST score from preoperatively to 6 months postoperatively.
The numbers in the first row and first column represent the RST score. Mean nasalance scores are shown in Table 4. No significant difference was observed between preoperative and postoperative mean nasalance scores. In , Adams remarked that his patients with NPH became quiet and had slow speech that progressively developed into whispering or no ability to speak at all.
Of 53 probable patients with NPH, only 1 was identified as a nonresponder after shunt placement surgery. After shunt placement, significant improvement was observed in swallowing function, speech characteristic resonation , and speech quality increasing volume. Statistically significant correlations were found between swallowing problem and gait disturbance, articulation disorder and gait disturbance, and speech problem and cognitive impairment.
Interestingly, no previous investigation has reported on bulbar dysfunction in NPH, even though dysphagia is a very common feature in neurological disorders. We also found bulbar dysfunction to be significantly correlated with TMSE score. One patient was lost to follow-up due to pneumonia with sepsis. The diseases of the patients before NPH consisted of 7 with supratentorial tumor, 3 with supratentorial ICH, 2 with subarachnoid hemorrhage, 1 with traumatic epidural hematoma, and 1 with previous craniectomy.
None of the patients had bulbar symptoms when they had these diseases before NPH and they experienced a good recovery after treatment. As such, the comorbid disease of secondary NPH in the present study should not have caused the bulbar palsy. The patients with neurological lesions that cause bulbar palsy were not enrolled because of the exclusion criteria. Based on our clinical experience, we observed that severity of bulbar symptoms correlated well with late or worsening NPH triad symptoms, which were usually found in cases with severe apathy or sleepiness.
Inadequate drainage after CSF shunting also correlated with worsening of bulbar symptoms. As such, they can be used as landmark symptoms for diagnosis and treatment monitoring. There are 2 possible pathoanatomical causes of bulbar dysfunction in NPH. The first cause involves PVWM damage. Levine et al.