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| Long-term outcomes of erectile function in adult orchidopexy patients |
Mazen Ahmed Ghanema,b,*( ),Essa Ahmed Adawia,Ahmed Mazen Ghanemc,Ahmed Asaad Ghanemd
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aDepartment of Urology, Jazan University, Jazan, Saudi Arabia
bDepartment of Urology, Menoufia University, Shebin El-Kom, Egypt
cKasr Al-Ainy Faculty of Medicine, Cairo University, Cairo, Egypt
dFaculty of Medicine, Mansoura University, Mansoura, Egypt |
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Abstract Objective: Cryptorchidism affects up to 6% of full-term male infants, and orchidopexy has been shown to reduce impaired spermatogenesis and malignant risks significantly. However, the relationship between orchidopexy and sexual function has not been investigated. Therefore, this study aimed to evaluate sexual function outcomes in adult patients who underwent orchidopexy for unilateral undescended testis in childhood. Methods: Totally, 58 adult patients who underwent unilateral orchidopexy in childhood were enrolled in the study. Erectile dysfunction (ED) was assessed by the International Index of Erectile Function (IIEF)-15 questionnaire. All participants underwent serum (testosterone and follicular stimulating hormone levels) measurement and semen analysis. Paternity rates were evaluated to assess the patient's fertility. Additionally, anxiety, depression, and stress were measured by the self-rating anxiety scale, self-rating depression scale, and visual analogue scale, respectively. Results: There was no statistically significant difference between IIEF-15 scores (intercourse satisfaction, orgasmic function, sexual desire, or overall satisfaction) comparing the cryptorchidism group with the control group; however, the ED was significantly higher in the cryptorchidism patients (p=0.000). At the median follow-up of 16.3 years, 15.5% of our patients complained of moderate to severe ED. Most patients were satisfied with their overall relationship and only 34.5% were not satisfied. Anxiety, depression, and stress were more prevalent in cryptorchidism than in healthy men (anxiety: 72.4% vs. 20.7%; depression:19.0% vs. 5.2%; stress:60.3% vs. 10.3%; p˂0.05). Additionally, ED was negatively associated with anxiety, depression, and stress symptoms (r=-0.518, p=0.000; r=-0.448, p=0.000; r=-0.591, p=0.000, respectively). Moreover, ED had a significant correlation with advancing age, psychological factors (anxiety, depression, and stress), infertility, and low levels of testosterone (p˂0.05). Conclusion: Low testosterone, infertility, and psychological burden (anxiety, depression, and stress) are used as factors for predicting ED outcomes after orchidopexy for undescended testis to guide physicians to evaluate the efficacy of testosterone replacement and psychological support in their management.
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Received: 19 June 2023
Available online: 20 October 2024
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Corresponding Authors:
* Department of Urology, Jazan University, Jazan, Saudi Arabia.E-mail address: mazenghanem99@yahoo.co.uk (M.A. Ghanem).
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| Characteristic | Value | | Age at presentation, year | 23.8 (22.9-27.4) | | Follow-up, year | 16.3 (15.8-16.6) | | Age at operation, year | 2.1 (1.8-2.5) | | Location of testis | | Inguinal canal | 49 (84.5) | | Superficial inguinal pouch | 9 (15.5) | | Laterality | | Right | 21 (36.2) | | Left | 37 (63.8) | | Fertility status | | Normozoospermia | 25 (43.1) | | Oligozoospermia | 27 (46.6) | | Azoospermia | 6 (10.3) | | Men without children | 16 (27.6) | | Total postoperative complication | 6 (10.3) | | Inguinal hernias | 4 (6.9) | | Hydrocele | 2 (3.4) |
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Patient's demographic and clinical data (n=58).
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| IIEF-15 domaina | Patient (n=58) | Control (n=58) | p-Valueb | | ED score (6-30) | | | 0.000 | | Median (IQR) | 24 (19-26) | 28 (24-30) | | | 6-10 (severe) | 2 (3.4) | 1 (1.7) | | | 11-17 (moderate) | 7 (12.1) | 3 (5.2) | | | 18-25 (mild) | 18 (31.0) | 13 (22.4) | | | 26-30 (no ED, normal) | 31 (53.4) | 41 (70.7) | | | Intercourse satisfaction score (0-15) | | | 0.379 | | Median (IQR) | 12 (8-13) | 13 (8-13) | | | 0-12 (dissatisfied) | 17 (29.3) | 19 (32.8) | | | 13-15 (satisfied) | 41 (70.7) | 39 (67.2) | | | Orgasmic function score (0-10) | | | 0.569 | | Median (IQR) | 9 (8-9) | 9 (8-9) | | | 0-8 (dysfunctional) | 7 (12.1) | 5 (8.6) | | | 9-10 (normal function) | 51 (87.9) | 53 (91.4) | | | Sexual desire score (2-10) | | | 0.133 | | Median (IQR) | 7.0 (6.0-8.0) | 7.5 (7.0-8.0) | | | 2-8 (dysfunctional desire) | 39 (67.2) | 38 (65.5) | | | 9-10 (normal desire) | 19 (32.8) | 20 (34.5) | | | Overall satisfaction score (2-10) | | | 0.638 | | Median (IQR) | 7 (6-9) | 8 (7-9) | | | 2-8 (dissatisfied) | 20 (34.5) | 18 (31.0) | | | 9-10 (satisfied) | 38 (65.5) | 40 (69.0) | | | VAS score | 8 (3-9) | 2 (1-2) | 0.036 | | SAS score, median (IQR) | | | 0.008 | | Median (IQR) | 51 (51-61) | 25 (18-41) | | | <50 | 12 (20.7) | 46 (79.3) | | | 50-59 | 29 (50.0) | 10 (17.2) | | | 60-69 | 13 (22.4) | 2 (3.4) | | | ≥70 | 4 (6.9) | 0 | | | SDS score | | | 0.000 | | Median (IQR) | 22 (15-33) | 9 (7-13) | | | <53 | 47 (81.0) | 55 (94.8) | | | 53-62 | 10 (17.2) | 2 (3.4) | | | 63-72 | 1 (1.7) | 1 (1.7) | | | >72 | 0 | 0 | |
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