Análise da função sexual de pacientes submetidos ao tratamento cirúrgico da fratura de pênis

Abstract

Evidence has shown a trend towards following urgent surgical exploration of penile fracture (PF) which aims to restore the anatomical and functional integrity of the penis, in order to avoid complications and sexual dysfunctions. The aim of this study was to conduct a comprehensive assessment of sexual function of patients undergoing surgical treatment of PF, covering psychological aspects related to trauma. Patients undergoing surgical treatment of PF from January 2014 to August 2017 were followed-up in our department for at least 6 months. Those patients answered the International Index of Erectile Function (IIEF-5), The Premature Ejaculation Diagnostic Tool (PEDT) and a psychosexual interview. Penile color duplex Doppler ultrasound (CDDU) was performed for those who had persistent erectile dysfunction (ED) to obtain a precise etiological diagnosis. Finally, we searched the penis and interviewed the patients about any evidence of pain in erection, penile nodules or curvature acquired after surgery. A total of 58 patients conducted the follow-up. The mean age was 38.5 years (range: 18-66 years). The sexual etiology was observed in 46 (79.3%) cases and non-sexual in 12 (20.6%). Only one patient had ED before the trauma. The duration of follow-up ranged from 6 to 48 months (mean: 11.4). Five (8.6%) patients had low libido, one (1.7%) patient reported delayed ejaculation and five (8.6%) developed acquired premature ejaculation. Eight (13.7%) patients complained of penile curvature after surgery. Intracavernosal injection test showed deviation < 30 ° in all cases. Penile fibrotic nodule was found in 44 (75.8%) patients and painful erections in 16 (27.5%) cases. Five (8.6%) patients complained of a decrease in the size of the penis in the postoperative period. Postoperative erectile function was recovered after six months in 50 (86.2%) cases. After the last evaluation at 18 months, only one patient developed persistent ED and CDDU excluded a vascular etiology. The only case of prior ED had no change in erectile function. Psychosexual evaluations showed that 45 (77.5%) patients feared a new episode of PF. Changes in sexual habits, such as avoiding vigorous sexual intercourse, were reported by 40 (68.9%) patients. Among 18 (31%) patients who reported a negative impact on sexual life, performance anxiety was performed by 17 (29.3%) of them. Of the 46 sexual etiology cases, 17 (36.9%) patients reported avoiding the position or cause that led to the trauma. Finally, patients with performance anxiety and those who reported a negative impact on sexual life were more susceptible to the development of ED (p = 0.0337 and p = 0.0418, respectively). Surgical treatment of PF provides satisfactory results with adequate recovery of sexual function, even in the long-term follow-up. Most patients preserve erectile function without the development of penile curvature or deformity. However, sexual complications such as ED, decreased libido, ejaculatory dysfunctions, curvature and penile nodule may occur in the late postoperative period and should be treated. Psychological sequela are very common, causing fear of recurrence and psychogenic ED, resulting in negative impact on the sexual life of these patients, who should be monitored closely.