Ejaculatory profiles and fertility in men after posterior urethroplasty for pelvic fracture-urethral distraction defect injuries.

OBJECTIVE: In men who sustain a pelvic fracture-urethral distraction defect (PFUDD) injury, repairing the urethra involves a complicated urethral anastomosis located posteriorly at the junction of the membranous and prostatic urethra. In this study we performed a post- operative semen analysis and questionnaire study to determine the effect of PFUDD injuries and PFUDD repair on ejaculatory function and fertility in these men. PATIENTS AND METHODS: With institutional review board approval, patients who had PFUDD repairs by one surgeon from 1990 to 2004 were identified from a database. Patients were contacted and given a questionnaire eliciting details about their ejaculatory function and history of fertility. Those interested in future paternity were asked to provide semen for analysis. RESULTS: In all, 32 men were contacted; all claimed to have antegrade ejaculation, although five reported having a lower ejaculatory volume than before their injury, and one claimed that his ejaculate was delayed. We assessed fertility in 19 men, six of whom had either infertility or abnormal semen analyses. CONCLUSIONS: All men in the present series who had PFUDD injuries repaired had antegrade ejaculation. Although six of 19 had either infertility or an abnormal semen analysis, it appears that the risk of damage to the ejaculatory ducts from either a PFUDD or the subsequent urethral reconstruction is low. However, other associated injuries at the time of the pelvic fracture might place these men at greater risk of infertility.

[Aortic surgery and sexual function]. / Chirurgia dell'aorta e funzione sessuale.

An account is offered of the haemodynamic and neurological questions posed by the relation between reconstructive aortoiliac surgery and sexual function. Attention is drawn to the anatomical and surgical features of the preaortic sympathetic structures. In the light of experience gained in pelvic haemodynamic evaluation with the Doppler penile pressure index, a method that has proved very useful in the study of pre- and postoperative impotence in the arteriopathic subject, stress is laid on three conclusions: a) the high frequency of impotence in aortoiliac arteriopathy (65% in a personal series); b) the beneficial effect on penile circulation of revascularisation of the hypogastric artery (increase in pressure index in 70% of cases); c) the relatively high incidence of postoperative sexual disturbances (30% in the personal series) due to lesion of the preaortic sympathetic structures, the risk being greater with techniques requiring wide exposure of the aorta. This danger is foreseeable in all sexually potent patients and should determine the indication for surgery, the method chosen (extra-peritoneal route, extra-anatomical by-pass), and the technique (in an aorto-femoral by-pass, the aorta should be prepared in accordance with carefully followed rules of surgical anatomy, and confined wherever possible to a short infrarenal segment).