Urinary and Sexual Outcomes Following Bulbar Urethroplasty–An Analysis of 2 Common Approaches

Abstract

OBJECTIVETo report success and patient reported urinary and sexual outcomes of patients who underwent anastomotic urethroplasty and dorsal buccal onlay urethroplasty. MATERIALS AND METHODSPatients who underwent primary transecting anastomotic or dorsal buccal onlay urethroplasty for bulbar strictures at our institution between 1998 and 2015 were analyzed. Patients who had a prior urethroplasty, involvement of a different portion of the urethra, or a diagnosis of lichen sclerosis (LS) or hypospadias were excluded. Outcomes were assessed by cystoscopy at 4 months, validated questionnaires assessing urinary, erectile, and ejaculatory function at the time of their most recent assessment. RESULTSA total of 40 and 139 patients were included in the dorsal buccal and anastomotic groups, respectively. Wide patency at 4-month cystoscopy was 97.5% and 100% (P= .06) and the long-term success was 95% and 99.3% (P= .06) with a mean follow-up of 51.4 and 63.3 months. Patient reported outcomes were similar with 2 exceptions: postvoid dribbling was reported more often in the onlay group (28.1% vs 8.3%, P< .0001), and tethering with erections in the anastomotic group (23.4% vs 3.1%, P= .008). Ninety-eight percent of patients in the anastomotic group and 91% in the dorsal buccal onlay group would choose their surgery again (P= .07). CONCLUSIONBoth anastomotic urethroplasty and dorsal onlay graft are associated with high success with comparable satisfaction. Patient reported outcome measures were similar regardless of approach, despite inherent differences in stricture length. Our data indicates that anastomotic urethroplasty should not be avoided due to concerns of sexual side effects. UROLOGY 130: 162−166, 2019.

Sexual function after anterior urethroplasty: a systematic review

“…In another comparison of EPA vs. dorsal graft urethroplasty, Furr et al (38) reported decreased glans filling in 10.6% and 9.4% of patients, respectively. They also found decreased penile sensation in 23.4% and 18.8% of EPA and grafting cohorts.…”

“…Furr et al (38) reported sexual results of their cohort of bulbar urethroplasties using EPA (96 patients) vs. dorsal BMG urethroplasty (32 patients). There were no significant differences between groups regarding IIEF5 postoperative score (BMG 18.4 vs. EPA 17.1), patients with IIEF5 >15 (BMG 69% vs. EPA 69%), potency or difficulty achieving erections (BMG 31% vs. EPA 27%).…”

“…Furr et al (38) compared EPA -selected for shorter (<3 cm), more proximal bulbar strictures-with dorsal BMG urethroplasty-typically reserved for longer strictures (>3-3.5 cm) or those located in distal bulbar urethra. They found no differences between groups in terms of postoperative MSHQ-EJD ejaculatory score or bother.…”

“…Furr et al (38) compares the results of EPA versus dorsal BMG urethroplasty in a series of 179 patients. Tethering with erections was significantly more frequent with EPA (23.4%) vs. BMG (3.1%).…”

Round up

“…performed a retrospective analysis of patients operated between 1998 and 2015 (40 underwent DBOU, Group I, while 139 AU, Group II) to compare the success and patient-reported urinary and sexual outcomes between the two methods. [18] The long-term success was 95% and 99.3% ( P = 0.06), with a mean follow-up of 51.4 and 63.3 months in Groups I and II, respectively. Patient-reported outcomes were similar in both the groups.…”