To evaluate clinical and patient-reported urinary and sexual outcomes after a long-segment stricture repair using the one-sided urethral dissection, penile invagination and dorsal BMG onlay technique described by Kulkarni.
Patients from four institutions after single-stage repairs for long-segment urethral strictures (> 8 cm) from January 2002 to April 2016 were reviewed. Technique described by Kulkarni et al was used in all cases. Clinical outcomes included uroflowmetry (Qmax), post-void residuals (PVR). PROMs included IPSS survey, SHIM, Male Sexual Health Questionnaire (MSHQ-EjS) and Global Response Assessment questionnaire (GRA) to measure voiding, sexual, ejaculatory symptoms and overall improvement respectively.
Seventy-three patients with a minimum of 12-months follow-up were included. The mean age and stricture length were 56(21-80) years and 13.6(8-21) cm respectively. At a mean follow-up of 44(12-162) months, 9/73(12%) strictures recurred. The mean baseline IPSS score of 23(7-24) decreased to 10(1-17) on follow-up (p <0.001). 8/42 patients (21.4%) reported an increase and 6/42 patients (14.3%) decrease in SHIM following urethroplasty. Ejaculatory function on MSHQ-EjS improved after urethroplasty from 8 pre-operatively to 11 post-operatively (p<0.004). All patients reported improvement after urethroplasty on GRA questionnaire. Post-void dribbling and chordee occurred in 45% and 25% of patients respectively.
Durable patency in most patients is demonstrated in this study. Patient-reported outcome measures indicate an improvement in urinary function and moderate effect on sexual function. Transient penile chordee was evident in 25% of patients.
Urology. 2017 Aug 29 [Epub ahead of print]
Jeffrey Spencer, Stephen Blakely, Michael Daugherty, Javier C Angulo, Francisco Martins, Krishnan Venkatesan, Dmitriy Nikolavsky
SUNY Upstate Medical University 750 E. Adams Street, Department of Urology, Syracuse, NY 13210., Departamento Clinico, Facultad de Ciencias Biomedicas y de la Salud, Universidad Europea de Madrid, Laureate Universities, Madrid, Spain; Servicio de Urologia, Hospital Universitario de Getafe, Madrid., Departamento de Urologia, Universidade de Lisboa, Hospital de Santa Maria, Lisboa, Portugal., Department of Urology, Medstar Washington Hospital Center, 110 Irving Street NW, suite 3b-19, Washington DC 20010., SUNY Upstate Medical University 750 E. Adams Street, Department of Urology, Syracuse, NY 13210. Electronic address: .