دانلود رایگان مقاله انگلیسی اثر اورترپلاستی بر اضطراب و افسردگی - الزویر 2018

Introduction and Objective: Anxiety and depression (AD) in patients with urethral stricture disease (USD) and the impact of urethroplasty on mental health has never been explored. We hypothesized that patients with USD will have higher than normal AD levels and urethroplasty would improve mental health. Methods: Patients undergoing anterior urethroplasty were retrospectively reviewed from a multi-institutional reconstructive urology database. Pre- and postoperative evaluation of AD and overall health was recorded using the validated EQ-5D-3L Questionnaire, while sexual function was evaluated with the International Index of Erectile Function (IIEF) and Men’s Sexual Health Questionnaire (MSHQ). Stricture recurrence was defined as the need for subsequent procedure. Results: Median follow-up of the 298 that met inclusion criteria was 4.2 months. Preoperative AD was reported by 86 (29%) patients. Patients with AD reported higher rates of marijuana use, worse preoperative IIEF score (17.5 vs 19.6, p=0.01), and lower image of overall health (66 vs. 79, p=<0.001). Improvement or resolution of AD was experienced by 56% patients undergoing urethroplasty. De novo postoperative AD was reported by 10%. These men reported decreased flow rates (16 ml/sec vs 25 ml/sec; p=0.01). Clinical failure (8 patients, 2.7%) had no effect on the development, improvement, or resolution of AD. Conclusions: 56% of patients with preoperative AD reported improvement or resolution after urethroplasty. Although new onset AD was rare, these patients had a significantly lower postoperative max flow rate, possibly representing a group with a perceived suboptimal surgical outcome. A USD specific questionnaire is needed to further elucidate the interplay between USD and AD.

CONCLUSION

The majority of patients with baseline AD experienced an improvement or resolution of AD after urethroplasty. Preoperative sexual dysfunction and a poor image of overall health are associated with the presence of baseline AD as well as new onset postoperative AD. Although the development of new onset AD was rare, patients exhibited a decreased max flow, suggesting a perceived suboptimal surgical result. Identifying patients at-risk for AD who may benefit from referral for further evaluation is important. A more comprehensive USD specific patient questionnaire is needed to elucidate the interplay between USD and AD.