COMPARISON OF SEXUAL FUNCTION AFTER RETROGRADE INTRARENAL SURGERY AND URETEROSCOPY: A RETROSPECTIVE COHORT STUDY

Abstract

Objective: Retrograde intrarenal surgery (RIRS) and ureteroscopy (URS) are widely adopted minimally invasive techniques for treat ing upper urinary tract stones. However, their comparative effects on sexual function remain poorly understood. This study aimed to compare the impact of RIRS versus URS on sexual function and identify risk factors for prolonged dysfunction. Material and Methods: In this retrospective cohort study, we analysed 360 propensity scorematched patients (180 pairs) who underwent RIRS or URS between January and December 2022. Sex ual function was assessed using validated questionnaires (IIEF5, PEDT, MSHQ for males; FSFI, OABq SF for females) at baseline and 3, 6, and 12 months postoperatively. The primary outcome was the change in sexual function scores; the secondary outcomes included the recovery time and complication rates. Results: RIRS patients showed significantly greater decreases in sexual function scores at 3 months (mean difference: −2.8 points, 95% CI: −3.9 to −1.7, p<0.001), with effects diminishing by 12 months. Recovery rates were higher in the URS group (94.2% vs 89.7%, p=0.008). Age >60 years (HR: 2.3, 95% CI: 1.83.1) and stones >15 mm (HR: 2.2, 95% CI: 1.72.9) were independent predictors of prolonged recovery. Stonefree rates (82.0% vs 84.9%) and complications (10.5% vs 14.1%) were comparable between the groups. Conclusion: RIRS is associated with a more pronounced but temporary impact on sexual function compared with URS. These f indings can inform preoperative counselling and procedure selec tion for highrisk patients.

Keywords

• Retrograde intrarenal surgery
• ureteroscopy
• sexual dys function
• urolithiasis
• endourology

RETROGRAD İNTRARENAL CERRAHİ VE ÜRETEROSKOPİ SONRASI CİNSEL İŞLEVİN KARŞILAŞTIRILMASI: RETROSPEKTİF KOHORT ÇALIŞMASI

Abstract

Amaç: Retrograd intrarenal cerrahi (RIRC) ve üreteroskopi (URS), üst üriner sistem taşlarının tedavisinde yaygın olarak kullanılan minimal invaziv tekniklerdir. Ancak, bu prosedürlerin cinsel fonksiyon üzerindeki karşılaştırmalı etkileri yeterince anlaşılamamıştır. Bu çalışma, RIRC ve URS’nin cinsel fonksiyon üzerindeki etkilerini karşılaştırmayı ve uzamış disfonksiyon için risk faktörlerini belirlemeyi amaçlamıştır. Gereç ve Yöntemler: Bu retrospektif kohort çalışmasında, Ocak Aralık 2022 tarihleri arasında RIRC veya URS uygulanan propensity skor eşleştirilmiş 360 hasta (180 çift) analiz edildi. Cinsel fonksiyon, valide edilmiş anketler kullanılarak (erkekler için IIEF5, PEDT, MSHQ; kadınlar için FSFI, OABq SF) başlangıçta ve postoperatif 3, 6 ve 12. aylarda değerlendirildi. Primer sonlanım noktası cinsel fonksiyon skorlarındaki değişim; sekonder sonlanım noktaları iyileşme süresi ve komplikasyon oranlarıydı. Bulgular: RIRC hastalarında 3. ayda cinsel fonksiyon skorlarında anlamlı düşüş gözlendi (ortalama fark: −2,8 puan, %95 GA: −3,9 ile −1.7, p<0,001), bu etki 12. ayda azaldı. İyileşme oranları URS grubunda daha yüksekti (%94,2′ye karşı %89.7, p=0,008). 60 yaş üstü (HR: 2,3, %95 GA: 1,83,1) ve 15 mm üzeri taşlar (HR: 2,2, %95 GA: 1,72,9) uzamış iyileşmenin bağımsız prediktörleriydi. Taşsızlık oranları (%82,0′ye karşı %84,9) ve komplikasyonlar (%10,5′e karşı %14,1) gruplar arasında benzerdi. Sonuç: RIRC, URS’ye kıyasla cinsel fonksiyon üzerinde daha belirgin ancak geçici bir etkiye sahiptir. Bu bulgular, yüksek riskli hastalarda preoperatif danışmanlık ve prosedür seçimine yön verebilir

Keywords

• Retrograd intrarenal cerrahi
• üreteroskopi
• cinsel işlev bozukluğu
• ürolitiyazis
• endoüroloji

References

1. Sorokin I, Mamoulakis C, Miyazawa K, Rodgers A, Talati J, Lotan Y. Epidemiology of stone disease across the world. World J Urol 2017;35(9):1301-20. google scholar
2. Geraghty RM, Cook P, Walker V, Somani BK. Evaluation of the economic burden of kidney stone disease in the UK: a retrospective cohort study with a mean follow-up of 19 years. BJU Int 2020;125(4):586-94. google scholar
3. Türk C, Petřík A, Sarica K, Seitz C, Skolarikos A, Straub M, et al. EAU Guidelines on interventional treatment for urolithiasis. Eur Urol 2016;69(3):475-82. google scholar
4. De S, Autorino R, Kim FJ, Bhandari A, Rane A, Kenney P, et al. Percutaneous nephrolithotomy versus retrograde intrarenal surgery: a systematic review and meta-analysis. Eur Urol 2015;67(1):125-37. google scholar
5. Gul U, Altug U, Cakmak O, Yildirim I, Gurbuz C, Yalcin V. Impact of flexible ureterorenoscopy and laser lithotripsy on sexual function: a prospective study. Andrologia 2019;51(4):e13218. google scholar
6. Eryildirim B, Tuncer M, Sahin C, Yucetas U, Sarica K. Evaluation of sexual function in patients submitted to ureteroscopic procedures. Int Braz J Urol 2015;41(4):791-5. google scholar
7. Malhotra NR, Kaufman MR, Kwan L, Aboian M, Gonzalez CM. Evaluation of sexual function outcomes following endourological procedures. Curr Urol Rep 2018;19(11):89. google scholar
8. Yoshioka T, Otsuki H, Uehara S, Shimizu T, Murao W, Fujio K, et al. Sexual function outcomes after endourological stone surgery: A systematic review and meta- analysis. J Endourol 2020;34(7):795-9. google scholar

9. Seklehner S, Sievert KD, Lee R, Engelhardt PF, Riedl C, Kunit T. A systematic review and meta-analysis on the efficacy of flexible ureterorenoscopy for upper urinary tract stone disease. Eur Urol Focus 2021;7(5):1166-81. google scholar
10. Sahan M, Sarilar O, Akbulut MF, Ozgor F, Savun M, Nuhoglu B. Sexual function outcomes following flexible ureterorenoscopy: A prospective matched-pair analysis. Andrologia 2020;52(3):e13524. google scholar
11. Lee JY, Kang DH, Chung DY, Kwon JK, Lee H, Cho NH, et al. Sexual dysfunction and quality of life following ureteroscopic lithotripsy: a prospective, multicentre study. World J Urol 2019;37(8):1721-7. google scholar
12. Kazmi Z, Umer D, Ather MH. The Effect of Ureteric Stenting on Female Sexual Function: A Prospective Cohort Study. Cureus 2020;12(10):e11075. google scholar
13. Cho SY, Jeong H, Cho MC, Choi YS, Yang DY, Kim JK, et al. Sexual Function and quality of life after urological stone surgery: a prospective multicenter study. Urology 2021;147:133-9. google scholar
14. Zheng J, Yang Z, Xie Y, Huang X, Lin W, Lai S, et al. Sexual function after retrograde intrarenal surgery: A matched cohort study. Urol Int 2019;102(3):344-50. google scholar
15. Alkan E, Arpali E, Ozkanli AO, Basar MM, Acar O, Balbay MD. RIRS is equally efficient and safe in patients over 65 years compared to younger patients: A matched pair analysis. World J Urol 2019;37(7):1429-33. google scholar
16. Kiremit MC, Guven S, Sarica K, Ozturk A, Buldu I, Kafkasli A, et al. Contemporary management of medium-sized (10-20 mm) renal stones: A retrospective multicenter observational study. J Endourol 2018;32(10):960-5. google scholar
17. Malhotra NR, Kaufman MR, Kwan L, Aboian M, Gonzalez CM. Evaluation of sexual function outcomes following endourological procedures. Curr Urol Rep 2018;19(11):89. google scholar
18. Akdeniz E, Bolat MS, Sahinkaya N, Irkilata L, Dimitropoulos K, Gul M. Sexual dysfunction after retrograde intrarenal surgery for renal stones: A prospective study. Int J Impot Res 2021;33(7):723-9. google scholar