Urethroplasty For Bulbar Urethral Stricture Research Articles

Outcomes of transecting versus non-transecting urethroplasty for bulbar urethral stricture: a meta-analysis.

To assess outcomes of transecting vs non-transecting urethroplasty for bulbar urethral stricture in terms of stricture recurrence rate, sexual dysfunction, and patient-reported outcome measures (PROMs) related to lower urinary tract (LUT) function. Electronic literature searches were conducted using PubMed, Cochrane Library, Web of Science and Embase databases. The studied population was limited to men with bulbar urethral stricture included in studies that compared outcomes after transecting and non-transecting urethroplasty. The main outcome appraised was the stricture recurrence rate. Additionally, the incidence of sexual dysfunction appraised in three domains (erectile function, penile complications, and ejaculatory function) and PROMs related to LUT function after transecting vs non-transecting urethroplasty were assessed. The pooled risk ratio (RR) respectively for stricture recurrence, erectile dysfunction and penile complications was calculated using a fixed-effect model with inverse variance method. In all, 694 studies were screened with 72 identified as relevant. Finally, 19 studies were suitable for analysis. The pooled difference between the transecting and non-transecting groups relating to stricture recurrence was not significant. Overall, the RR was 1.06 (95% confidence interval [CI] 0.82-1.36) and the 95% CI crossed the line of no effect (line RR = 1). Overall, the RR for erectile dysfunction was 0.73 (95% CI 0.49-1.08) and the 95% CI crossed the line of no effect (line RR = 1). Overall, the RR for penile complications was 0.47 (95% CI 0.28-0.76) and the 95% CI did not cross the line of no effect (line RR = 1). Hence, the risk of penile complications was significantly lower in the non-transecting group. Our analysis of available evidence indicates that both transecting and non-transecting urethroplasties, are equal in terms of the recurrence rate. On the other hand, non-transecting techniques are better in terms of sexual function, causing less penile complications.

Buccal mucosa graft urethroplasty for bulbar urethral stricture: Outcomes andpredictive factors affecting success

Introduction and objectiveThe bulbar urethra is the location where urethral stricture is most commonly observed. The most successful method for long and recurrent urethral stenosis is graft urethroplasty. The most successful graft source is buccal mucosa, with advantages like easy adaptation to the corporeal bed, thick epithelium, thin lamina propria with rich vascular structure and easy ability to obtain the graft. In this study we aimed to retrospectively assess the outcomes and predictive factors affecting surgical success of our buccal mucosal graft urethroplasty surgery performed for bulbar urethra stenosis with moderate length. Material and methodIn this study, we monitored 51 patients with mean 4.4 cm bulbar urethral stricture length for mean 17 months follow-up. From operative and postoperative data, stenosis length, operation duration, Qmax, International Prostate Symptom Score, International Index of Erectile Function-Erectile Function and OF, success rates in total and in subgroups (age, according to DVIU, etiology, BMI and DM), follow-up duration, complications, re-stricture time and number were assessed. ResultsThe total success of the operations was 86.3%. In 17 months, the re-stricture rate was 13.7%. Oral and urethral complications were all minor. The complications with longest duration (6 months) were ejaculation, erection problems and urethral fistula. Mean time to re-stricture was 11 months. All re-stricture patients were relieved by one DVIU session each. ConclusionFor bulbar urethral stricture longer than 2 cm and with recurrence, the dorsal buccal mucosa graft replacement is a very successful method with low complication rates.

P0400 - The efficacy of non-transecting urethroplasty for bulbar urethral stricture - A retrospective study from a urethral referral center

P0400 - The efficacy of non-transecting urethroplasty for bulbar urethral stricture - A retrospective study from a urethral referral center

P0315 - Free graft augmentation urethroplasty for bulbar urethral strictures – Which technique is best? A systematic review

P0315 - Free graft augmentation urethroplasty for bulbar urethral strictures – Which technique is best? A systematic review

Outcome of Anastomotic Urethroplasty for Bulbar Urethral Stricture Our Experience

Objective: For evaluation of patients who underwent bulbar end-to-end anastomosis to assess surgical outcome. Materials and Methods: We reviewed 53 patients with an average age of 44 years who underwent bulbar end-to-end anastomosis from January 2013 to July 2018. A total of 9 patients (16.98%) underwent urethrotomy, dilation, or multiple treatments before referral to our center. Stricture length d”2cm, free from infection and completed at least 6 months of follow up were included. Patients were evaluated post operatively by uroflowmetry at 3, 6, 12 months of follow up and yearly thereafter. Clinical outcome was considered a treatment failure when any postoperative instrumentation was needed. Results: Mean age 44 (SD±7.6, range 33 to 54 years). Stricture etiology was blunt perineal trauma 32 (60.37%), infection 12(22.64%), idiopathic 06(11.32%) and iatrogenic 03(05.67%). Mean operation time was 95 minutes (range, 50 to 140 minutes) and mean excised stricture length was 1.4 cm (range, 0.5 to 2 cm). 44 patients (83.02%) were symptom-free and required no further procedure. Strictures recurred in 9 patients (16.98%) within 2 to 5 months after surgery. Of 9 recurrences, 3 patient was managed successfully by urethrotomy, whereas the remaining 6 did not respond to urethrotomy or dilation and required additional urethroplasty. Conclusions: Excision and end-to-end anastomosis urethroplasty is an excellent procedure for short segment bulbar urethral stricture. Bangladesh Journal of Urology, Vol. 23, No. 1, January 2020 p.56-61

Double-face augmentation urethroplasty for bulbar urethral strictures: Analysis of short-term outcomes.

To present our initial experience with double-face augmentation urethroplasty for near-obliterative bulbar urethral strictures and analyze the short-term outcomes. We retrospectively evaluated a prospectively maintained database of patients with near-obliterative bulbar urethral strictures (>2 cm), who underwent double-face augmentation urethroplasty. The patients' demographic characteristics, clinical data, and data regarding the investigations conducted were analyzed. Near-obliterative urethral stricture was defined as lumen <6 Fr. Double-face urethroplasty was performed using a ventral approach, during which dorsal inlay and ventral onlay buccal mucosal graft (BMG) augmentation were performed. A successful outcome was defined as normal voiding without the need for any instrumentation to improve the urinary flow rate. A total of 37 patients with a mean age of 50±11.7 years, who underwent this procedure were included in the study. The mean stricture length was 5.2±0.95 cm. The mean length of the dorsal inlay BMG augmentation was 3.1±0.5 cm and that of the ventral onlay BMG augmentation was 6.3±1.2 cm. Post-void dribbling (18.9%) was the most commonly reported complication. The maximum flow rates and symptom scores significantly improved in both groups compared with the preoperative parameters (p<0.001). The incidence of both erectile dysfunction and ejaculatory failure was reported in 6 (16.2%) patients; respectively. The overall success rate was 86.5% at a median follow-up period of 36 months (IQR: 26.5-43). Double-face augmentation urethroplasty is a safe and feasible option for near-obliterative bulbar urethral strictures, and our study showed satisfactory short-term outcomes for the same.

Patient-reported outcomes after buccal mucosal graft urethroplasty for bulbar urethral strictures: results of a prospective single-centre cohort study.

To describe patient-reported outcome measures (PROMs) after buccal mucosa graft (BMG) urethroplasty. We prospectively collected PROMs in patients who underwent BMG urethroplasty for bulbar urethral strictures between October 2009 and February 2017. Preoperatively and at the first, second and third postoperative follow-up visits, patients completed five PROM questionnaires: the International Prostate Symptom Score (IPSS); the IPSS Quality of Life questionnaire; the Urogenital Distress Inventory Short-Form questionnaire (UDI-6); the International Index of Erectile Function (IIEF)-5 questionnaire, combined with IIEF-Q9 and IIEF-Q10 for assessing ejaculatory and orgasmic functions; and the International Consultation on Incontinence Questionnaire Lower Urinary Tract Symptoms Quality of Life (ICIQ-LUTS-QOL) questionnaire. In addition to using these questionnaires, we evaluated maximum urinary flow rate (Qmax ), post-void residual urine volume and total voided urine volume at each follow-up visit. Buccal pain and discomfort were assessed using a visual analogue scale (VAS). Comparison of questionnaire scores was performed using a paired Wilcoxon rank-sum test. Treatment failure was defined as any need for urinary diversion or urethral instrumentation after surgery. A total of 97 patients met the inclusion criteria. The first postoperative follow-up visit was at a median of 2.1months (n = 97/97), and the second and third visits were after a median of 7.8 (n = 82/97) and 17.0months (n = 70/97), respectively. Significant improvements compared to baseline were observed in IPSS, and IPSS-QOL, UDI-6 and ICIQ-LUTS-QOL scores at the first follow-up, and remained improved during the follow-up period (P ≤ 0.001). Patients with mild to no baseline erectile dysfunction experienced a significant decline in erectile function at the first follow-up (median [interquartile range {IQR}] preoperative IIEF-5 score 23.0 [21.0-25.0] vs median [IQR] IIEF-5 score at first follow-up 19.5 [16.0-23.8]; P ≤ 0.001). This decline fully recovered during further follow-up (median [IQR] IIEF-5 score at third follow-up 24.0 [20.5-25.0]; P = 0.86). No significant changes in median orgasmic and ejaculatory function were noted. The first postoperative median (IQR) VAS score was 3.0 (2.0-4.45), and a significant improvement in local pain and discomfort was observed during the follow-up (median [IQR] VAS at third follow-up: 0.0 [0.0-1.0]; P ≤ 0.001). Nine patients (9/97; 9.3%) had treatment failure. Stratifying recurrence based on a difference of <10mL/s vs ≥10mL/s between preoperative and postoperative Qmax could not demonstrate a significant difference (P = 0.06). Significant improvements in voiding symptoms and quality of life after surgery were reported. Patients with good baseline erections recovered erectile function during follow-up, although a significant decrease in erectile function was observed at the first follow-up. This study highlights the importance of PROMs in urethral reconstructive surgery, emphasizing that success should not be defined only by stricture-free survival.

192 - A prospective analysis of patient-reported outcome measures after buccal mucosa graft urethroplasty for bulbar urethral strictures

192 - A prospective analysis of patient-reported outcome measures after buccal mucosa graft urethroplasty for bulbar urethral strictures

Dorsal onlay buccal mucosa graft urethroplasty for bulbar urethral stricture: a single centre experience.

Introductionthe successful treatment for urethral strictures demands not just attention to surgical details but careful selection of the reconstructive technique. For long segment urethral strictures substitution urethroplasty is required. This study sought to determine the success rate and complications of dorsal onlay buccal mucosal graft (BMG) urethroplasty for long segment urethral strictures in our hospital.Methodsthis was a retrospective study carried out at Jos University Teaching Hospital from March 2015 to March 2018. The case notes of male patients who had dorsal onlay buccal mucosal graft urethroplasty for long segment bulbar urethral stricture within the study period were retrieved. Patients´ demographics, cause and nature of urethral strictures, duration of follow up, the success rate and complications were collected and subjected to statistical analysis using SPSS® version 22.Resultstwenty-four men with mean age of 45 years (range 14-67 years) had dorsal onlay buccal mucosal graft urethroplasty during the study period. The mean stricture length was 4.5cm (range, 2-7cm). After a mean follow up duration of 2 years (range, 1 4 years), 21(87.5%) patients had a successful urethroplasty as they were able to pass urine at one year post urethroplasty without lower urinary tract symptoms, while 3(12.5%) had recurrence of the urethral stricture. At the recipient site, 2(8.3%) patients had primary bleeding that did not require blood transfusion. Also, 2(8.3%) patients had superficial wound infection which was treated with antibiotics. At the donor site, 4(16.7%), 2(8.3%), 4(16.7%) had donor site swelling, transient bleeding and soreness respectively.Conclusiondorsal onlay BMG urethroplasty has a good success rate and minor complications and therefore suitable for long segment bulbar urethral strictures.

Is minimal invasive technique harmful in treatment of urethral stricture?

Our goal was to evaluate the effect of previous history of direct vision internal urethrotomy (DVIU) on success rate of open urethroplasty in patients with bulbar urethral stricture. We analyzed 133 patients who underwent open urethroplasty for bulbar urethral stricture between January 2008 and May 2017. Patients with penile and fossa navicularis stricture were excluded. We evaluated the effect of previous history of DVIU on success rate of open urethroplasty in patients with urethral stricture. Success of open urethroplasty was defined as disappear of voiding symptoms with maximum flow rate above 15 ml/s. The patients were followed for complications and outcome. Mean age was 54.05 ± 16.5 years. Mean length of stricture was 23.74 ± 10.23 mm. Mean follow-up was 39.77 ± 28.0 months. A total of 76 patients (57.1%) had no history of DVIU. On the contrary, 15.8% had history of DVIU once, 12% had twice, and 15.2% had more than twice. Success rate of open urethroplasty in patients who had no history of DVIU was 84%. However, this success rate was 71.4% in patients who had history of DVIU (P = 0.001). DVIU is easy, simple, and noninvasive technique in treatment of urethral stricture, so it is frequently used among urologists. However, it could not be an alternative technique to open urethroplasty. Internal urethrotomy can be used in some certain indications. Success rate of open urethroplasty can be affected by previous history of any endoscopic procedures.

Characterization of a Standardized Postoperative Radiographic and Functional Voiding Trial after One-Stage Bulbar Ventral Onlay Buccal Mucosal Graft Urethroplasty and the Impact on Stricture Recurrence-Free Survival

PurposeTo characterize a standardized postoperative radiographic and functional voiding trial and determine its impact on outcomes after substitution urethroplasty. Materials and MethodsThis is an observational, monocentric study of men undergoing one-stage ventral onlay buccal mucosal graft urethroplasty for bulbar urethral stricture between 01/2009 and 12/2016. Patients were stratified by voiding trial success versus failure (radiographic: extravasation or residual narrowness; functional: postvoid residual volume >100ml) 21 days postoperatively. Endpoints were voiding trial failure and recurrence-free survival. Regression models were created to determine risk factors of voiding trial failure and to evaluate the impact of voiding trial failure on recurrence. ResultsOf 513 men, 437(85.2%) and 76(14.8%) succeeded and failed at voiding trial, respectively. Of the latter, 54(71.1%) showed evidence of extravasation, and 22(28.9%) had residual narrowness or failed functionally. In multivariable logistic regression analyses, no preoperative predictor of voiding trial failure was found (all P>0.05). At a median follow-up of 32 months, both Kaplan-Meier analyses (log-rank test: P=0.033) and multivariable Cox regression analyses (hazard ratio=1.86; P=0.037) revealed an association of voiding trial failure and stricture recurrence. When further stratifying voiding trial failure, residual narrowness or functional failure (hazard ratio=4.60; P<0.001) but not extravasation (hazard ratio=1.08; P=0.9) was a risk factor of recurrence. Limitations include the retrospective assessment of investigated endpoints. ConclusionsResidual narrowness or functional failure at an early voiding trial after buccal mucosal graft urethroplasty may predict stricture recurrence. Identification of intraoperative complexity factors predicting initial voiding trial failure might be a key to identify those individuals who recur early.

A Prospective Study of Patient-reported Pain After Bulbar Urethroplasty

To understand the prevalence of chronic perineal pain, activity limitations, and patient satisfaction after urethroplasty. From 2014 to 2016, we prospectively enrolled men undergoing urethroplasty for bulbar urethral strictures. Patients, before and after surgery, completed questions from the Core Lower Urinary Tract Symptom Score assessing pain frequency in the bladder and penis or urethra, as well as nonvalidated questions assessing perineal pain. Overall satisfaction with their current urinary condition and pain-related activity limitations at home, work, or during exercise were also measured. Patients with <3 months of follow-up were excluded. Pre-and postoperative scores were compared using the Wilcoxon signed-rank test. Thirty-five men were included in the study. Mean age and body mass index were 44.6 years and 30.9 kg/m2, respectively. Urethroplasties were anastomotic in 24 (69%) and were single-stage buccal graft substitution in 11 (31%). Median follow-up after surgery was 483 days (range: 90-810 days). A total of 10 patients (29%) reported worsening perineal pain intensity after surgery, whereas 8 (23%) reported improvement and 17 (48%) reported no change. Overall, pain frequency in the bladder, penis or urethra, and perineum improved. Home and exercise pain-related activity restrictions improved significantly after surgery. Satisfaction with current urinary condition also improved with 91% reporting feeling "delighted," "pleased," or "mostly satisfied" with their current condition. Patients are highly satisfied with their urinary condition after urethroplasty. Pain frequency in the bladder and the urethra significantly improves after urethroplasty; however, perineal pain intensity can worsen and become chronic after surgery in some patients.

Analyse des taux de succès des urétroplasties pour sténoses de l’urètre bulbaire chez l’homme adulte : revue systématique de la littérature

The aim of this review of literature was to evaluate the success rates of different techniques of urethroplasty for strictures of the bulbar urethra. We performed a systematic review of the MEDLINE literature from 2004 to 2015 following the PRISMA's statement recommendations. Key words were: urethroplasty, urethral reconstruction, onlay, graft, urethral stricture. Inclusion criteria were original articles describing the results of urethroplasty for bulbar urethral stricture in an adult male population. A minimum follow-up of 24 months was required. From 891 articles of the literature, 20 are studied in this review. Only 3 studies were prospective. The success rate of anastomotic urethroplasty varied from 68.7 to 98.8% for strictures from 1 to 3.5cm, from 60 to 96.9% for augmented urethroplasty performed for strictures from 4.2 to 4.7cm. Substitution urethroplasty with grafts presented from 75 to 89.8% of success for strictures from 2.6 and 4.36cm. Overall, 19/20 studies used buccal mucosal graft. The success rate of urethroplasty for bulbar urethral stricture is high; the surgical technique should be adapted to the length of the stricture.

Architecture of the Corpus Spongiosum: An Anatomical Study

Urethral reconstruction is performed for urethral stricture or hypospadias correction. Research on urethral tissue engineering is increasing. Because the corpus spongiosum is important to support the urethra, urethral tissue engineering should ideally be combined with reconstruction of a corpus spongiosum. We describe a method to visualize and measure the architecture of the corpus spongiosum, which is needed for scaffold design. The penis was dissected from 2 unembalmed male cadavers. One penis was flaccid and the other was erect, as induced by saline infusion. Both were frozen in ice. At 6 sites sections were obtained in the transverse and frontal directions. After digitalizing the stained sections the images were edited, area measurements were taken and a 3-dimensional reconstruction was made. In transverse sections the mean area of the vascular lumen was 60% and 77% in the flaccid and the erect corpus spongiosum, and in frontal sections it was 53% and 74%, respectively. This indicated a 129% transverse increase and a 140% longitudinal increase in erection. Section sites did not essentially differ except in the glans penis. Frontal sections showed larger vascular cavities and more incomplete septae than transverse sections. This study provides what is to our knowledge novel information on corpus spongiosum architecture, which is relevant for scaffold design in tissue engineering. The study protocol can be used in future research with a larger number of specimens and more extensive analyses.

Urethral Stricture Disease: Challenges and Ongoing Controversies.

Urethral Stricture Disease: Challenges and Ongoing Controversies.

Repeat Excision and Primary Anastomotic Urethroplasty for Salvage of Recurrent Bulbar Urethral Stricture

We compared the results of initial excision and primary anastomosis urethroplasty to the excision and primary anastomosis outcomes of other challenging reoperative clinical settings, including secondary cases (prior urethroplasty of any technique other than excision and primary anastomosis) and repeat cases (prior excision and primary anastomosis). We reviewed our database of patients who underwent excision and primary anastomosis urethroplasty for bulbar urethral stricture atour tertiary referral center from 2007 to 2014. Patients without available dataand those with a history of lichen sclerosus, radiation, pelvic fracture urethral injuries, distal strictures and/or hypospadias were excluded from analysis. Patient characteristics and outcomes were compared between those undergoing initial, secondary, and repeat excision and primary anastomosis urethroplasty for bulbar urethral stricture. Among 898 urethroplasties performed during the study period we identified 305 men who underwent excision and primary anastomosis urethroplasty ofthe bulbar urethra, including an initial procedure in 268 of 305 (88%) and reoperation in 37 (12%). Of patients with reoperation 18 of 37 (49%) underwent secondary excision and primary anastomosis following a different type of prior urethroplasty and 19 (51%) underwent repeat excision and primary anastomosis. Repeat excision and primary anastomosis in the bulbar urethra was successful in18 of 19 patients (95%), which was comparable to the success rate of initial bulbar excision and primary anastomosis (251 of 268 or 94%) as well as secondary bulbar excision and primary anastomosis (17 of 18 or 94%, p = 0.975) with a similar mean stricture length. Mean followup for all patients was 41.5 months (range 6 to 90) and mean followup in each group was greater than 30 months. Repeat excision and primary anastomosis urethroplasty has excellent results for short bulbar strictures, comparable to those achieved in the initial and secondary setting.

Surgical Tips and Tricks During Urethroplasty for Bulbar Urethral Strictures Focusing on Accurate Localisation of the Stricture: Results from a Tertiary Centre

BackgroundThere are several techniques for characterising and localising an anterior urethral stricture, such as preoperative retrograde urethrography, ultrasonography, and endoscopy. However, these techniques have some limitations. The final determinant is intraoperative assessment, as this yields the most information and defines what surgical procedure is undertaken. ObjectiveWe present our intraoperative approach for localising and operating on a urethral stricture, with assessment of outcomes. Design, setting, and participantsA retrospective review of urethral strictures operated was carried out. All patients had a bulbar or bulbomembranous urethroplasty. All patients were referred to a tertiary centre and operated on by two urethral reconstructive surgeons. Surgical procedureIntraoperative identification of the stricture was performed by cystoscopy. The location of the stricture is demonstrated externally on the urethra by external transillumination of the urethra and comparison with the endoscopic picture. This is combined with accurate placement of a suture through the urethra, at the distal extremity of the stricture, verified precisely by endoscopy. Outcome measures and statistical analysisClinical data were collected in a dedicated database. Intraoperative details and postoperative follow-up data for each patient were recorded and analysed. A descriptive data analysis was performed. Results and limitationsA representative group of 35 male patients who had surgery for bulbar stricture was randomly selected from January 2010 to December 2013. Mean follow-up was 13.8 mo (range 2–43 mo). Mean age was 46.5 yr (range 17–70 yr). Three patients had undergone previous urethroplasty and 26 patients had previous urethrotomy or dilatation. All patients had preoperative retrograde urethrography and most (85.7%) had endoscopic assessment. The majority of patients (48.6%) had a stricture length of >2–7cm and 45.7% of patients required a buccal mucosa graft. There were no intraoperative complications. Postoperatively, two patients had a urinary tract infection. All patients were assessed postoperatively via flexible cystoscopy. Only one patient required subsequent optical urethrotomy for recurrence. ConclusionsOur intraoperative strategy for anterior urethral stricture assessment provides a clear stepwise approach, regardless of the type of urethroplasty eventually chosen (anastomotic disconnected or Heineke-Mikulicz) or augmentation (dorsal, ventral, or augmented roof strip). It is useful in all cases by allowing precise localisation of the incision in the urethra, whether the stricture is simple or complex. Patient summaryWe studied the treatment of bulbar urethral strictures with different types of urethroplasty, using a specific technique to identify and characterise the length of the stricture. This technique is effective, precise, and applicable to all patients undergoing urethroplasty for bulbar urethral stricture.

Ventral Oral Mucosal Onlay Graft Urethroplasty in Nontraumatic Bulbar Urethral Strictures: Surgical Technique and Multivariable Analysis of Results in 214 Patients

BackgroundThe ventral oral mucosal onlay graft is suggested in proximal bulbar strictures where the thick spongiosum provides excellent support to the graft. Some technical steps used in this technique are currently under debate in the literature. ObjectiveTo describe the surgical steps of this urethroplasty and investigate predictive factors of success using a multivariable logistic regression analysis. Design, setting, and participantsThis is a descriptive observational retrospective study of 214 patients who underwent urethroplasty for bulbar urethral strictures between May 1999 and November 2010 in a single high-volume center. Study inclusion criteria were patients presenting nontraumatic bulbar urethral strictures ranging from 1.3cm to 6.8cm in length. Exclusion criteria were traumatic strictures, panurethral strictures, lichen sclerosus, and failed hypospadias repair. Surgical procedureThe oral graft was placed on the ventral bulbar urethral surface and pushed as proximally as possible using dedicated instruments and surgical techniques. Outcome measurements and statistical analysisThe primary outcome measure was the objective result, defined as the absence of stricture recurrence at follow-up. The objective outcome was considered a failure when any postoperative instrumentation was needed. Multivariable logistic regression analysis was developed. All tests were two sided with a significance level set at 0.05. Results and limitationsMedian follow-up was 54 mo. Of the 214 patients, 183 (85.5%) were successful and 31 (14.5%) were failures. The preoperative maximum flow rate (Qmax) was a significant predictor of surgical outcome (odds ratio: 1.352; p = 0.001). Age, length, and type of stenosis, and previous treatment were not significant predictors of surgical outcome (all p > 0.05). The limitation of our survey is the absence of a subjective evaluation or the use of specific tools, such as a questionnaire. ConclusionsVentral oral graft urethroplasty represents a valid option in nontraumatic bulbar strictures. Preoperative Qmax may be predictive of urethroplasty failure.

Low Risk of Sexual Dysfunction After Transection and Nontransection Urethroplasty for Bulbar Urethral Stricture

Open urethroplasty is the preferred treatment for recurrent bulbar urethral stricture. However, there are still some controversies regarding the optimal technique and the consequences of transecting the urethra in terms of sexual dysfunction, such as erectile dysfunction, penile shortening, impaired glans filling, decreased glans sensibility and ejaculatory function. We performed a retrospective analysis with long-term followup of anastomotic and substitution onlay urethroplasty in bulbar strictures with an emphasis on postoperative sexual function. A total of 169 patients with bulbar stricture were treated with urethroplasty via the onlay technique (75) or resection followed by end-to-end anastomosis (94) during 1999 to 2009. Mean followup in the transection and onlay groups was 41 and 69 months, respectively (range 12 to 132). All patients were asked verbally about sexual function during followup. Failure was defined as the need for new surgical intervention. Erectile dysfunction developed in 1 patient (1%) per group. In the transection group 5 patients (5%), including 4 with longer and more distal strictures, had penile shortening/downward angulation. However, this did not interfere with sexual ability during intercourse. No patient reported impaired glans or ejaculatory function. The success rate in the transection and onlay groups was 91% and 71%, respectively. Transection with resection and end-to-end anastomosis is a good method for bulbar stricture with a low rate of sexual dysfunction and a high success rate postoperatively. To avoid penile angulation/shortening, it might be wise to use the onlay technique for longer and distal strictures.

724 Resection with end to end anastomosis versus onlay urethroplasty for bulbar urethral strictures: Long term follow up of 162 patients in a single center experience

724 Resection with end to end anastomosis versus onlay urethroplasty for bulbar urethral strictures: Long term follow up of 162 patients in a single center experience