URS and ED risk: Intriguing association
It is intriguing to consider ureteroscopy as having a risk association for erectile dysfunction (ED), as a study discussed in a recent Urology Times article may suggest.
The epidemiology of male sexual dysfunctions includes a host of novel risk factors that have increasingly come to light with such studies only in the past several years. Risk factors conceivably include a host of iatrogenic conditions from medication prescriptions to surgeries.
Although this study is suggestive of a risk association, the authors astutely recognize several relevant limitations: retrospective study design, small patient sample, limited follow-up interval, and most importantly, selection bias. It is entirely possible that the patients reporting ED were self-selected in reporting this complication that actually may be no greater in incidence than that seen in an appropriate control group.
Hence, collecting data from all study participants without dropout and making a comparison with an equally health- and demography-matched control group, such as perhaps men undergoing shock wave lithotripsy, would have offered a more robust conclusion that a risk association between ureteroscopy and ED exists. One must keep in mind the high likelihood that many individuals undergoing ureteroscopy may harbor some sexual function decline by virtue of their underlying adverse health risks for nephrolithiasis, including obesity, metabolic syndrome, and adverse lifestyle risk factors that have been documented similarly as ED risk factors.
Nevertheless, it is purposeful to consider the possibility that ureteroscopy could constitute a risk factor for ED. The association here would seemingly implicate other endoscopic procedures as risk factors as well if the hypothesis of a mechanistic effect relating to genital trauma from performing such procedures is plausible. If this is so, continued careful performance of these procedures as urologists must be underscored.
Indeed, iatrogenic associations with ED are conceivably preventable to some extent, such that our best efforts as urologists to limit their impact are paramount.
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