The effect of double J stent placement on sexual dysfunction during endoscopic urinary tract stone treatment

Objective: We aimed to investigate whether endoscopic stone treatment applied for the treatment of kidney and ureteral stones differ between groups with or without stent in terms of sexual functions. Material-Method: Endoscopic ureteral stone treatment performed, 134 male, married and had an active sexual life patients, between ages of 20-65 years old were included in our study. The patients were informed about the study. The consent form was signed. In our clinic, patients who will be treated for endoscopic ureter and kidney stones were filled in the International Erectile Function Index (IIEF) form before surgery. The answers of this form were recorded, which evaluated erectile function, satisfaction with sexual intercourse, orgasmic function, sexual desire and general satisfaction. The patients of the demographic characteristics, the size and location of the stones, the density of the stone, the procedure applied were determined and recorded. It was decided whether the patients would be stented during the operation, regardless of the study. The patients were divided into 2 groups as with and without double J stent; stented group (Group 1, n = 83) and non-stent group (Group 2, n = 51). Patients who had DJS implanted postoperatively were filled in the IIEF form on the day of stent removal 4 weeks later and when they came to the control examination 4 weeks after the stent was removed. The patients who did not have stent were filled in the IIEF form when they came to the control examination 4 weeks later. General demographic characteristics and IIEF form results were compared. Results: Between the groups; age (Group1 = 44.84 ± 11.47 and Group2 = 43.02 ± 11.47 p = 0.37), BMI (Group1 = 25.46 ± 2.56 and Group2 = 25.08 ± 2.98 kg / m2, p = 0.43), there was no statistically significant difference between the pre-operative total scores of IIEF (Group1 = 56.43 ± 15.42 and Group2 = 56.06 ± 13.67 p = 0.88). Stone size between the groups (Group1 = 12.42 ± 5.43 and Group2 = 7.76 ± 2.60 mm, p <0.001), stone density (Group1 = 1045.18 ± 321.26 and Group2 = 852.94 ± 166.55 HU, p <0.001), operation time (Group1 = 74.10 ± 26.36 and Group2 = 52.55 ± 15.47 min, p <0.001), the amount of laser energy used during the operation (Group1 = 11987.95 ± 4473.48 and Group2 = 7137.25 ± 3200.12 j, p <0.001) and postoperative IIEF total scores (Group1 = 42.12 ± 15.78 and Group2 = 48.82 ± 14.03, p = 0.01), a statistically significant difference was found. When Group 1 was analyzed within itself, preoperative, postoperative and control values were 56.43 ± 15.42, postoperative 42.12 ± 15.78, and the control value after stent removal was 53.45 ± 17.04. It is observed that there is a statistically significant difference between each other (p <0.001), only pre-operation and control values are observed to be close to each other. In summary, postoperative decreasing values of total IIEF and sub-scores, when done at the time of control, increased to pre-operative values and no statistically significant difference was found. In summary, When Group 2 was evaluated within itself, a statistical difference was found in the total scores of IIEF before and after the operation (56.06 ± 13.67 / 48.82 ± 14.03, p <0.001). Conclusions: In this study, we investigated endoscopic ureter stone treatment and DJS implantation during treatment whether caused sexual dysfunction in male patients. In patients with DJS implantation, it is observed that sexual functions are negatively affected in the postoperative period, but increase to pre-operative values after DJS is removed. We think, that sexual functions are negatively affected in patients without stent, although they are milder than those with stent. In patients without DJS, we see that physical and emotonial situations are effectef in the postoperative period, possibly due to stone dropping and lower urinary symptoms. In our study, we found temporary sexual dysfunction in patients who underwent endoscopic stone treatment and DJS implantation. In addition, we found transient sexual dysfunction in patients who were not implanted with stents, although they were less affected. Studies involving more patients are needed in order to show more clearly the effects of endoscopic urinary system stone treatment and stent placement on male patients on sexual functions.