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Sir,

We read this article [1] with interest regarding the incidence of de novo erectile dysfunction (ED) after anterior urethroplasty. The authors have tried to clear the ‘grey areas’ in anterior urethroplasty and ED. However, the authors need to address some issues. We would like to know the basis by which the authors calculated the incidence of ED, as no clear cut universal definition for ED was followed in the different studies. Of a total 36 studies, preoperative data about ED was only available in five studies [457 patients (≈20%) out of the total 2323], so how did the authors calculate that some patients developed de novo ED, as their preoperative status was unknown. It also needs to be clarified at what time after surgery erectile function was assessed and how the authors concluded that there was a 1% incidence of ED. Moreover, the total number of patients with ED was 165, which is 7.1 % of the total 2323 patients.

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