Graft Urethroplasty Research Articles

Comparison of quality of life and sexual function before and after anterior urethral reconstruction surgery

The study assessed the impact of anterior urethral reconstruction surgery on quality of life and sexual function in 22 male patients with anterior urethral strictures. The mean age was 51 years (range: 25–88), and strictures were localized in the bulbar urethra, penile urethra, or both, with an average stricture length of 4.2 cm. Etiologies included trauma, iatrogenic causes, infections, and idiopathic factors. Surgical techniques included end-to-end urethroplasty, dorsal onlay oral mucosa graft urethroplasty, and combined dorsal graft with ventral augmentation. Significant postoperative improvements were noted in urinary symptoms, with IPSS scores reducing from severe to mild in all patients (p<0.001) and Qmax increasing from a mean of 3.23 ml/s to 19.46 ml/s (p<0.001). Preoperative quality of life, evaluated using EQ-5D and EQ-VAS, showed significant enhancement, with EQ-VAS scores improving from 38.77 to 77.05 (p<0.001). Sexual function, assessed via IIEF-5, remained stable, with no significant postoperative decline (p=0.463), highlighting the preservation of erectile function. USS-PROM evaluations revealed a substantial reduction in symptom severity and improved patient satisfaction. The findings demonstrate that anterior urethral reconstruction effectively restores urinary function and improves quality of life without compromising sexual health, establishing it as a safe and reliable treatment for anterior urethral strictures.

Outcomes of Double-Face Buccal Mucosal Urethroplasty for Treating Anterior Urethral Stricture in Adult Males.

To assess the results of double-face buccal mucosal graft urethroplasty (BMG) for treating anterior urethral stricture in adult males. An observational study. Place and Duration of the Study: Department of Urology, Sindh Institute of Urology and Transplantation, Karachi, Pakistan, from 2021 to 2022. The inclusion criteria were adult males, aged 15 to 70 years, with a previous surgical procedure for hypospadias and the presence of long penile and bulbar strictures measuring over 2 cm, resulting from a straddle injury. Forty-three patients were selected who underwent urethroplasty in 2021 and completed a one-year follow-up in 2022. Uroflowmetry (UFM) and the International Index of Erectile Function (IIEF) assessment data were obtained from the patients' medical records. Success was defined as the patient attaining catheter freedom and achieving a maximum flow rate exceeding 15 ml/sec after one year. The mean UFM at one year was 20.89 ml/s. Four patients underwent endo-urological intervention (direct visual internal urethrotomy), and one patient needed a second double-face urethroplasty. After one year, the double-face BMG urethroplasty achieved an overall success rate of 88.4%. Double-face BMG urethroplasty is a reliable and effective surgical technique for the treatment of near obliterative or obliterative long anterior urethral strictures. Buccal mucosal graft urethroplasty, Direct visual internal urethrotomy, Anterior urethral stricture, Buccal mucosal graft, Urethral dilatation.

Outcomes of Double-Face Buccal Mucosal Urethroplasty for Treating Anterior Urethral Stricture in Adult Males.

To assess the results of double-face buccal mucosal graft urethroplasty (BMG) for treating anterior urethral stricture in adult males. An observational study. Place and Duration of the Study: Department of Urology, Sindh Institute of Urology and Transplantation, Karachi, Pakistan, from 2021 to 2022. The inclusion criteria were adult males, aged 15 to 70 years, with a previous surgical procedure for hypospadias and the presence of long penile and bulbar strictures measuring over 2 cm, resulting from a straddle injury. Forty-three patients were selected who underwent urethroplasty in 2021 and completed a one-year follow-up in 2022. Uroflowmetry (UFM) and the International Index of Erectile Function (IIEF) assessment data were obtained from the patients' medical records. Success was defined as the patient attaining catheter freedom and achieving a maximum flow rate exceeding 15 ml/sec after one year. The mean UFM at one year was 20.89 ml/s. Four patients underwent endo-urological intervention (direct visual internal urethrotomy), and one patient needed a second double-face urethroplasty. After one year, the double-face BMG urethroplasty achieved an overall success rate of 88.4%. Double-face BMG urethroplasty is a reliable and effective surgical technique for the treatment of near obliterative or obliterative long anterior urethral strictures. Buccal mucosal graft urethroplasty, Direct visual internal urethrotomy, Anterior urethral stricture, Buccal mucosal graft, Urethral dilatation.

Decision regret and long-term success rates after ventral buccal mucosa graft urethroplasty.

To characterise the long-term success rate of ventral onlay buccal mucosa graft urethroplasty (vBMG) in the management of bulbar urethral stricture disease (USD), assess patient-reported postoperative satisfaction and decision regret, and delineate clinical factors impacting patient-reported metrics. Patients with prior vBMG for bulbar USD, performed at Cleveland Clinic between 2003 and 2022, were contacted and brief structured interviews were performed. Stricture recurrence and need for secondary procedures, baseline demographics, and patient-reported outcome surveys were collected. The surveys included the Decision Regret Scale (DRS), the Urethral Stricture Symptom Impact Measure (USSIM) and the 10-item Patient-Reported Outcomes Measurement Information System Short Form, version 1.2 (PROMIS-10). Descriptive, univariate and multivariable analyses were performed for clinical outcomes and survey responses. A total of 104 patients recorded responses. The median patient age was 49 years and the median follow-up was 7.4 years at time of survey. The median graft length was 5 cm and 38% of patients underwent partial thickness augmented anastomotic urethroplasty. At time of follow-up, 10 patients underwent a secondary procedure. Moderate to severe regret on the DRS was found in 12% of patients, and greater regret was associated with recurrence. The mean physical and mental health PROMIS-10 Global Health T-scores were 52 and 53. The mean total USSIM score was 56. A significant correlation was found between USSIM and DRS scores, with higher DRS score and recurrence negatively impacting USSIM score. USSIM scoring across all domains was significantly worse in the moderate to severe DRS group. This study showed that vBMG for bulbar USD confers both high success rates and patient-reported satisfaction at extended follow-up, based on emerging and validated patient-reported outcome measures.

259 - Ventral inlay versus dorsal onlay buccal mucosal graft urethroplasty for female urethral stricture; Randomized control trial

259 - Ventral inlay versus dorsal onlay buccal mucosal graft urethroplasty for female urethral stricture; Randomized control trial

Reply to Editorial Comment on “Comparative Analysis of Dorsal Onlay Buccal Mucosal Graft and Vaginal Wall Graft Urethroplasty for Female Urethral Stricture at a Tertiary Care Centre”

Reply to Editorial Comment on “Comparative Analysis of Dorsal Onlay Buccal Mucosal Graft and Vaginal Wall Graft Urethroplasty for Female Urethral Stricture at a Tertiary Care Centre”

58 - Surgical Treatment of Complex Sexual Abuse Sequelae: a report of concurrent Buccal Mucosa Graft Urethroplasty, Autologous Sling, and Vulvoplasty.

58 - Surgical Treatment of Complex Sexual Abuse Sequelae: a report of concurrent Buccal Mucosa Graft Urethroplasty, Autologous Sling, and Vulvoplasty.

Editorial Comment on “Comparative Analysis of Dorsal Onlay Buccal Mucosal Graft and Vaginal Wall Graft Urethroplasty for Female Urethral Stricture at a Tertiary Care Centre”

Editorial Comment on “Comparative Analysis of Dorsal Onlay Buccal Mucosal Graft and Vaginal Wall Graft Urethroplasty for Female Urethral Stricture at a Tertiary Care Centre”

Urethroplasty- a single centre single surgeon experience.

Male urethral stricture affects 100 in 100,000 men. These are investigated using uroflowmetry, retrograde urethrography and cystourethroscopy. Management is usually endoscopic with urethral dilation or direct visual internal urethrotomy, although they have high failure rates. It is now recommended that urethroplasty is performed earlier. In this study we have reviewed a single surgeons experience with urethroplasty and patient outcomes. We retrospectively reviewed a prospectively maintained database of all urethroplasty operations performed in our hospital over a 5 -year period. Forty-five patients were identified, with a mean age of 46. The most common presenting symptom was poor flow (100%). Uroflowmetry was performed in 31 of 45 patients(69%). More patients had a urethrogram (58%) than flexible cystoscopy (38%). Most strictures were idiopathic (67%). Mean stricture length was 2.6cm. 71% did not require any further intervention. Five patients required repeat surgery. Four required DVIU and one required a repeat urethroplasty. The most popular techniques for urethroplasty in the UK are augmentation urethroplasty using a buccal mucosal graft and anastomotic urethroplasty, both of which we describe. There are variations in what is deemed as successful surgery. The most widely used definition is 'the lack of need for any further operative intervention'. We have recently adopted Patient Reported Outcome Measures using a validated questionnaire to measure the patients perception of a successful outcome. Complex strictures have a higher incidence of complications. 42% of our cohort were complex and we describe results comparable to the published literature.

Current Potential Outcomes of Buccal Mucosal Graft Anterior Urethroplasty for Male Urethral Stricture: A Single-Centre Study in Nepal.

Objective This study evaluates the efficacy and potential complications of Buccal Mucosal Graft (BMG) urethroplasty for anterior urethral stricture over a 48-month follow-up. Method A retrospective review was conducted on 130 patients who underwent various types of BMG urethroplasty between 2012 and 2019. Data on patient demographics, stricture etiology, and anatomic sitewere collected. Adverse outcomes such as complications likeerectile dysfunction (ED)persisting for over 12 months, and post-micturition dribbling (PMD) were analyzed to determine success rates, recurrent stricture risk factors, complications, and the definition of failure as stricture recurrence during the 48-month follow-up period. Results Of the 130 patients, there was a recurrence in 15.4 % (20 males), yielding a success rate of 84.6% (n=110). ED was reported in 11% (n=14) and PMD in 14% (n=18). All instances of ED were non-organic, and patients were administered oral phosphodiesterase type 5 (PDE5) inhibitors. These complications were observed in 20 patients (15.4%); with urinary fistula (3.0%), graft contracture (2.3%), graft failure (3.8%), urinary tract infection (UTI) (3.0%), and wound infection (2.3%) being the most prevalent after penile urethroplasty. Univariate analysis indicated age (31-50 years, >50 = P<0.05) at surgery, etiology (Balanitis Xerotica Obliterans (BXO)= P<0.05), stricture length (4.1-8 cm, >8 cm = P<0.05), and location as significant predictors of stricture recurrence. However, multivariate analysis highlighted penile location (P<0.05) as the sole independent predictor for restricture during the follow-up period. Conclusion BMG urethroplasty demonstrates a substantial 84.6% success rate in treating anterior urethral stricture over a 48-month follow-up period. This outcome underscores the advancements in healthcare quality in resource-limited settings in countries like Nepal.

A single-institution experience with the Optilume Urethral Drug Coated Balloon for management of urethral stricture disease.

Urethral stricture disease is detrimental to quality of life. The Optilume Urethral Drug Coated Balloon (DCB) offers a solution utilizing a paclitaxel-coated balloon to expand strictures and prevent recurrence. Following the ROBUST trials, it has been proposed that DCB is more effective than conventional endoscopic management for recurrent, small anterior urethral strictures. Our study provides insights into practical applications and outcomes using DCB for urethral stricture disease. A retrospective review was performed of patients who underwent DCB for urethral strictures at our institution from November 2022 to August 2023 with follow-up evaluated through January 2024. Demographics, stricture characteristics, operative details, and postoperative outcomes were collected. Primary endpoint was need for repeat intervention as determined by symptomatic burden and subsequently postoperative post-void residual if obtained. Secondary endpoint was complication rate. Statistical analysis was conducted using STATA/BE17.0 software to create Kaplan-Meier curves for time to repeat intervention after treatment with DCB. Of 43 patients, 16 had no prior treatment. The other 27 had endoscopic treatment and of this group, 11 also had additional urethroplasty. Stricture etiologies included 20 iatrogenic, 14 idiopathic, 5 radiation-related, 2 inflammatory, and 2 traumatic. Stricture locations were 2 fossa navicularis, 7 pendulous, 17 bulbar, 7 membranous, 3 prostatic, and 7 bladder neck contractures. Mean balloon dilation lasted 8.4±2.7 minutes. All patients had a minimum follow-up of 150 days postoperatively and the mean duration of follow-up for the cohort was 290.3±87.0 days. The average postoperative post-void residual was 33.4±90.6 milliliters. Two patients had immediate complications: 1 with urinary retention after catheter removal requiring suprapubic tube placement and 1 with urinary tract infection requiring antibiotics. Four patients required repeat interventions: 1 endoscopic dilation, 1 graft urethroplasty, and 2 repeat DCB procedures. Mean time to repeat intervention was 203.5±82.6 days, and no patient required repeat intervention within 145 days of initial surgery. DCB offers a safe and less invasive treatment for both treatment-naïve and recurrent urethral strictures with paclitaxel coating to prevent recurrence. Repeat intervention was not required for 90.7% of our cohort within an average follow-up duration of 9 months postoperatively. As DCB grows in clinical use, investigation into its long-term efficacy is justified.

The urinary and sexual outcomes of buccal mucosal graft urethroplasty versus end-to-end anastomosis: a systematic review with meta-analysis.

The urinary and sexual outcomes after urethroplasty may be a concern for patients, but there are still some controversies regarding the consequences of buccal mucosal graft urethroplasty (BMG) in terms of erectile dysfunction (ED). This meta-analysis aimed to compare urinary and sexual outcomes of BMG and end-to-end urethroplasty (EE). The PubMed, Web of Science, Cochrane, and Embase databases were searched until February 31, 2023. Data extraction and quality assessment were performed by 2 designated researchers. Dichotomous data were analyzed as odds ratios with 95% confidence intervals (CIs). Heterogeneity across studies was assessed by the I2 quantification, and publication bias using Begg's and Egger's tests. Meta-analysis was performed using RevMan software. Outcomes included stricture recurrence, ED, penile complications, and voiding symptoms. Eighteen studies, including 1648 participants, were included in our meta-analysis. The meta-analysis revealed that there was no significant difference in stricture recurrence (OR = 0.74; 95% CI, 0.48-1.13; P = .17) and voiding symptoms (OR = 1.12; 95% CI, 0.32-3.88; P = .86) between the BMG group and the EE group. BMG was associated with lower risk of penile complications (OR = 0.40; 95% CI, 0.24-0.69; P = .001) and ED (OR = 0.53, 95% CI, 0.32-0.90, P = .02). The study may help clinicians choose procedures that achieve better recovery of the urological and sexual function in the treatment of urethral stricture. This meta-analysis is the first to evaluate the urinary and sexual outcomes of BMG vs EE. A limitation is that most of the included studies were retrospective cohort studies. BMG is as effective as EE in the treatment of bulbar urethral stricture, but BMG has fewer complications and ED than EE.

Ambulatory buccal mucosal graft urethroplasty in geriatric population: A practice change experience

ABSTRACT Context: Due to the overwhelming burden of coronavirus disease 2019, buccal mucosal graft (BMG) urethroplasty in the elderly has been shifted from inpatient to ambulatory at our center in early 2020. Aim: This study aims to describe our experience with ambulatory BMG urethroplasty in the elderly and compare its feasibility and safety to inpatient urethroplasty before and after the practice change. Setting and Design: A pre and postpractice change retrospective cohort study of patients aged 65 years or above with BMG urethroplasty performed at our center between March 2018 and May 2022. Materials and Methods: Demographics, clinical characteristics, postoperative course, and complications were compared in ambulatory (discharged within 6 h) versus inpatient BMG urethroplasty groups. Statistical Analysis: A pre-and post-practice change retrospective cohort study of patients aged 65 or older with BMG urethroplasty performed at our centre between March 2018 and May 2022. Results: Of 37 BMG urethroplasties, 15 (40.5%) were inpatient, whereas 22 (59.5%) were ambulatory. Immediate complication rate was comparable in inpatient (2/15, 13.3%) and ambulatory cases (1/22, 4.5%): one wound infection in both groups and one recurrent urinary tract infection in the inpatient group. No oral cavity complications, bleeding/hematoma, or anesthesia-related morbidity were observed. There was no statistically significant difference in recurrence (13.3% vs. 9.6%; P = 0.98) and success rates (90.9% vs. 86.7%; P = 0.53) over a median of 53 (inpatient) and 34 (ambulatory) months follow-up. Conclusions: Ambulatory BMG urethroplasty, discharge within 6 hours of surgery, appears safe and feasible in geriatric populations (&gt;65), with no increased adverse outcomes. Factors like healthcare access, caregiver availability, and patient education play roles in discharge time. However, more robust studies are warranted for conclusive evidence.

Ventral Onlay Buccal Mucosa Graft Urethroplasty for Female Urethral Stricture: Medium-term Results in a Single Surgeon Experience

ObjectiveTo describe our own approach using buccal mucosal grafting and to assess the outcome of this approach. Materials and MethodsA total of 42 patients underwent ventral onlay BMG by a single surgeon between 2017 and 2022. A longitudinal incision along the length of the urethra was made through the anterior vaginal wall and the peri-urethral fascia was incised to create two flaps. This ventral urethrotomy ran from the meatus into the proximal health urethra above the level of the stricture.A buccal mucosal graft was harvested and sutured to the margins of the urethral mucosa itself and the flaps of peri-urethral fascia. The vaginal wall was then closed. ResultsThe mean age of the patients was 53.6 ± 12.8 years. There were no perioperative or postoperative complications. At a mean follow-up of 38.1 months, 41 patients (98%) were stricture-free. Peak flow rate improved from a mean of 7.7 ± 3.2 ml/s preoperatively to 25.9 ± 5.9 ml/s postoperatively. No patient developed incontinence. One patient developed a recurrent urethral stricture which was treated by redo urethroplasty. ConclusionsThe surgical technique applied has proved efficiency. The ventral BMG preserves the urethral sphincter and so avoids postoperative incontinence. The use of peri-urethral fascia represents a good vascular and mechanical support for the graft.

Editorial Comment: Complex Buccal Graft Urethroplasty Combined With HoLEP in the Setting of Concomitant Urethral Stricture Disease and Severe Benign Prostatic Hyperplasia: A Case Report

Editorial Comment: Complex Buccal Graft Urethroplasty Combined With HoLEP in the Setting of Concomitant Urethral Stricture Disease and Severe Benign Prostatic Hyperplasia: A Case Report

Comparison of Ventral Inlay and Dorsal Onlay Urethroplasty for Female Urethral Stricture

ObjectiveTo compare the outcomes of Ventral inlay buccal mucosal graft urethroplasty (VIBMGU) with dorsal onlay buccal mucosal graft urethroplasty (DOBMGU) for the treatment of Female urethral stricture (FUS). Material and MethodsThis study included women who underwent either VIBMGU or DOBMGU between January 2016 and June 2023. The preoperative AUA symptom scores, maximal urinary flow rate (Qmax), post-void residual volume (PVR) on ultrasonography, and length and location of the stricture were obtained from a prospectively maintained electronic database. The data obtained from the patient’s last visit was compared with the preoperative values for this study. The primary outcome was the success rate. The secondary outcomes were changes in AUA score, PVR, and Qmax. The patient's last follow-up visit was considered for the duration of the follow-up. ResultsSeventy-three patients were treated for BMGU for FUS. Forty-six patients underwent VIBMGU, and 27 patients underwent DOBMGU. The median duration of follow-up was 27.5 11.00-55.00) versus 14 (7.00-17.00) months respectively. The success rates of VIBMGU and DOBMGU were 89.13% and 88.89% respectively. There was a reduction in AUA scores and PVR and an improvement in Qmax postoperatively in both groups. The difference in the reduction in AUA scores between the VIBMGU and DOBMGU groups was statistically significant. The difference was not statistically significant in terms of reduction in PVR and improvement in Qmax between the two groups. ConclusionThe ventral inlay technique can provide equal results to the dorsal technique with the added advantage of vaginal sparing. This is the single largest series in the literature on female urethral stricture with the largest follow-up period of 90 months.

Current Trends in the Use of Buccal Grafts During Urethroplasty Among Society of Genitourinary Reconstructive Surgeons

ObjectivesTo analyze current standards in urethroplasty by urologists employing buccal mucosal grafts (BMG) for treating urethral stricture disease (USD). MethodsAn IRB-approved online survey was distributed to members of the Society of Genitourinary Reconstructive Surgeons (GURS) between July and October 2022 to assess BMG utilization in urethroplasty. Questions covered surgeon experience, graft harvest site, graft length, surgical technique, and perceived success rates. ResultsOf 350 invited GURS members, 134 responded (38%). 69% were GURS fellowship-trained, performing 10-30 urethroplasties annually. 95% harvested their own grafts, with 99% preferring buccal mucosa as the primary site. Buccal mucosa was favored over fasciocutaneous flap for penile urethroplasty, regardless of circumcision status (95% with, 84% without). For bulbar urethroplasty with BMG, dorsal graft placement was favored (66%) over ventral (34%). Most surgeons (90%) preferred multiple BMGs over combined graft/flap for panurethral strictures. When harvesting long grafts, 56% preferred using both cheeks. Anastomotic urethroplasty was preferred over buccal graft urethroplasty for short bulbomembranous stenosis post-radiotherapy (63% vs. 37%). Surgeons reported a success rate of 80-90% (53%). ConclusionsThe expanded scope of reconstructive urology has led to increased use of BMG in diverse urethral reconstructions. Buccal grafts are now preferred for penile, bulbar, and panurethral strictures, demonstrating high perceived success rates in the reconstructive community.

Results of Buccal Mucosa Graft Urethroplasty With or Without Reconstruction of the Meatus

Results of Buccal Mucosa Graft Urethroplasty With or Without Reconstruction of the Meatus

Uretroplastia femenina con injerto de mucosa oral en una etapa: resultados comunicados por las pacientes y tasas de éxito funcional a largo plazo

Introduction and objectivesFemale urethral strictures are a rare condition that significantly impacts patients’ quality of life. Patient-reported outcomes are crucial, yet data regarding sexual function and treatment satisfaction are scarce. We aimed to provide insights from a reconstructive referral center. Patients and methodsWe conducted a retrospective analysis of women treated with ventral onlay one-stage buccal mucosa graft urethroplasty for urethral strictures between 2009–2023. We assessed objective (retreatment-free survival, improvement in maximum flow rate) and subjective outcomes (validated patient-reported outcomes). ResultsOf 12 women, 83 and 17% had iatrogenic and idiopathic strictures, respectively. Median number of prior interventions was 6. Strictures were located meatal and mid-urethral in 25 and 75%, respectively, 22% had the bladder neck involved. Median graft length was 2cm. At median follow-up of 66 months, 33% of patients underwent stricture retreatment, but only one case occurred within the first 2 years postoperatively. The median improvement in maximum flow rate was 10ml/s. Median International Consultation on Incontinence Questionnaire Female Lower Urinary Tract Symptoms Modules (ICIQ-FLUTS) scores were 8 for filling symptoms, 6 for voiding symptoms, and 3 for incontinence symptoms. Median ICIQ-FLUTSsex score was 4. Higher scores indicate a higher symptom burden. Median ICIQ-Satisfaction outcome and satisfaction scores were 18 and 7, respectively, reflecting high treatment satisfaction. ConclusionsBuccal mucosal graft urethroplasty by ventral onlay for female urethral strictures yields effective, durable, and positively received outcomes. However, larger studies across multiple institutions are necessary to further assess its efficacy, especially regarding patient-reported experiences and sexual function.

Long-term functional success and patient-reported outcomes after female one-stage buccal mucosal graft urethroplasty

Introduction and objectivesFemale urethral strictures are a rare condition that significantly impacts patients’ quality of life. Patient-reported outcomes are crucial, yet data regarding sexual function and treatment satisfaction are scarce. We aimed to provide insights from a reconstructive referral center. Patients and methodsWe conducted a retrospective analysis of women treated with ventral onlay one-stage buccal mucosa graft urethroplasty for urethral strictures between 2009–2023. We assessed objective (retreatment-free survival, ΔQmax) and subjective outcomes (validated patient-reported outcomes). ResultsOf 12 women, 83% and 17% had iatrogenic and idiopathic strictures, respectively. Median number of prior interventions was 6. Strictures were located meatal and mid-urethral in 25% and 75%, respectively, 22% had the bladder neck involved. Median graft length was 2 cm. At median follow-up of 66 months, 33% of patients underwent stricture retreatment, but only one case occurred within the first 2 years postoperatively. The median improvement in maximum flow rate (ΔQmax) was 10 ml/s. Median International Consultation on Incontinence Questionnaire Female Lower Urinary Tract Symptoms Modules (ICIQ-FLUTS) scores were 8 for filling symptoms, 6 for voiding symptoms, and 3 for incontinence symptoms. Median ICIQ-FLUTSsex score was 4. Higher scores indicate a higher symptom burden. Median ICIQ-Satisfaction outcome and satisfaction scores were 18 and 7, respectively, reflecting high treatment satisfaction. ConclusionsBuccal mucosal graft urethroplasty by ventral onlay for female urethral strictures yields effective, durable, and positively received outcomes. However, larger studies across multiple institutions are necessary to further assess its efficacy, especially regarding patient-reported experiences and sexual function.