The protective effect of non-transecting urethroplasty on erectile function in patients with posterior urethral stricture

Abstract

Objective To explore the erectile function preservational mechanism of Non-transecting urethroplasty(NTU)for posterior urethral stricture. Methods From May 2012 to September 2016, 62 patients with posterior urethral stricture, who were treated with NTU, were enrolled in this study. The mean age was 37.5 years old, ranging 18-48 years old. The causes were pelvic fracture urethral injury in 53 cases and iatrogenic injury in 9 cases. Preoperative urethrography and urethroscopy revealed the strictures located in posterior urethra, which was at the distal of verumontanum. The mean length of stricture was 2.1 cm, ranging 0.5-2.5 cm. The average period between trauma and surgery was 6.4 months, ranging 3 months-2 years. All patients had no previous history of urethroplasty. Their sexual hormones were in normal level. Among those patients, the IIEF-5 scores were more than 12 and number of events during NPT test were more than twice. Finally, 43 cases were underwent NTU and 19 cases accepted inferior pubectomy (IP)+NTU. All patients had a general anesthesia. The bulbar urethra was mobilized dorsally from the tunica albuginea of the corpora cavernosa and then extended proximally up toward the perineal membrane. Scar tissue surrounding the urethra was excised and inferior pubectomy (IP) was performed as a supplemental technique to keep the suturing position without tension. The ventral hemi-circumference was then sutured with interrupted 4-0 polyglycolic sutures with tension-free anastomosis. The 18-Fr indwelling catheter was inserted. Result Average follow-up was 20.2 months, ranged from 12 to 36 months. In NTU group, NPT test revealed no significant difference in number of events(2.7±0.7 vs. 3.0±1.0, P>0.05), duration of best episode [(16.4±3.5)min vs. (16.4±3.8)min, P>0.05)] or tip rigidity[(31.2±4.7)% vs. (30.8±3.5)%, P>0.05)] between pre- and post-operation, respectively. The IIEF-5 score(19.7±1.9 vs.20.4±2.1, P<0.05 )and Qmax [(8.7±4.0)ml/s vs. (25.5±4.7)ml/s, P<0.05)] increased significant pre- and post-operation, respectively. In IP+NTU group, Qmax [(8.4±4.4)ml/s vs. (23.1±3.5)ml/s, P<0.05)] increased significant pre and post operation. The NPT test revealed slight decrease in number of events(2.3±0.6 vs. 1.6±1.0, P<0.05), duration of best episode [(15.6±2.4)min vs. (14.5±2.4)min, P<0.05)] or tip rigidity [(29.8±3.0)% vs. (25.6±7.1)%, P<0.05)] between pre- and post-operation, respectively. However, the IIEF-5 scores(17.3±1.6 vs.16.5±2.1, P<0.05) didn't show significant difference pre- and post-operation. Stricture recurrence occurred in 3 patients, the success rate was 95.2%(59/62) during 12 months following. Conclusion NTU is not only a safe and promising procedure for posterior urethral stricture less than 2.5cm, but also a new minimally invasive approach to preserve erectile function. Key words: Posterior urethral stricture; Non-transecting corpus spongiosum; Erectile function