Direct-vision internal urethrotomy, is erectile dysfunction a possible complication?

Erectile dysfunction is reported to be a complication of direct-vision inte rnal urethrotomy by some authors in 2.2-10.6% of cases. It is caused by inj ury to the cavernous nerve by direct severance with the cutting blade, late fibrosis after extravasation and infection, or by a shunt between the corp ora cavernosa and corpus spongiosum. The aim of this examination was to eva luate all internal urethrotomy patients from 1990 to 1999, regarding this k ind of complication. Of 184 patients, 111 had to be excluded due to preexisting erectile dysfunc tion, malignancy, age over 75 years, or open surgery of the urethra before internal urethrotomy. Five patients died. Of 184, 68 patients did not have erectile problems before the operation and only one complained about erecti le dysfunction following direct-vision internal urethrotomy. Further examin ation showed an impaired arterial inflow in both arteriae penis profunda; c avernosography could not prove a shunt between the corpora cavernosa and co rpus spongiosum. Erectile dysfunction is a possible complication of direct-vision internal u rethrotomy. External sphincterotomy at the 3- and 9-o'clock position, ureth rotomy after injury or open reconstructive surgery of the urethra, and uret hrotomy of long and dense strictures as well as a dilatation over 22 Chr. a re known to cause this complication. To inform the patient concerning this kind of complication is recommended before urethrotomy.