اثر اورترپلاستی بر اضطراب و افسردگی Effect of Urethroplasty on Anxiety and Depression

INTRODUCTION Mental health illnesses are common and treatable disorders that have a significant impact on the United States population. Approximately 20% of the U.S. adult population is affected by a mental illness each year.1 Anxiety and depression (AD) represent two of the most pervasive mental health disorders in the United States. In the field of reconstructive urology, the relationship between surgery and mental illness remains underexplored. Recent studies have reported the prevalence of urinary urgency and incontinence in patients with Urethral Stricture Disease (USD) and the significant impact these symptoms have on quality of life and emotional well-being.2,3 In addition, patients undergoing urethroplasty can develop erectile dysfunction4 , which has a previously well documented bi-directional association with depression.5,6 The prevalence of mental health disorders and the effect of urethroplasty on their natural history has, to our knowledge, previously never been published. In this study, we investigated the prevalence of baseline AD and the effect of urethroplasty on AD. We hypothesized that 1) USD would have a higher prevalence of AD compared to the national average, 2) urethroplasty will lead to resolution or improvement of AD, and 3) patients who develop denovo AD will have a poor image of overall health and decreased sexual function. METHODS Study population Institutional Review Board approval was obtained. From a prospectively maintained multi-institutional database, patients who underwent single-stage anterior urethroplasty between June 2013 and May 2016 were retrospectively identified from 6 surgeons who are members of the Trauma and Urologic Reconstruction Network of Surgeons (TURNS). Patients undergoing urethroplasty are followed according to a TURNS-specific protocol, which has been previously described.7 Patient demographics, etiology of USD, and postoperative complications were recorded. The most recent evaluation was used for postoperative analysis. Study Outcomes: 298 men completed both a preoperative and postoperative assessment of AD. Mental health and personal image of overall health were evaluated using the validated EQ-5D-3L Questionnaire.8 Regarding “Anxiety/Depression” (Item 5 of EQ-5D-3L), patients reported symptoms as “absent”, “moderate”, or “extreme”. Patients were asked to quantify their personal image of overall health using a scale of 1-100 with 1 representing “Worst imaginable health state” and 100 indicating “Best imaginable health state”. Sexual function was evaluated using the International Index of Erectile Function (IIEF)9 and ejaculatory function with the Men’s Sexual Health Questionnaire (MSHQ)10 .