Erectile and voiding function outcomes after buccal mucosa graft urethroplasty for long-segment bulbar urethral stricture: ventral versus dorsal onlay technique.

To compare the impact of dorsal versus ventral onlay buccal mucosa graft bulbar urethroplasty on postoperative erectile function status.

We retrospectively reviewed the records for 232 patients who underwent dorsal and ventral onlay buccal mucosa graft bulbar urethroplasty from March 2012 to April 2021. Outcomes were urinary and erectile function status as assessed by IIEF5-15 score at preoperative, three months, and 12 months post-urethroplasty. We compared the dorsal and ventral only techniques at the different follow-up visits using difference-in-differences analysis.

165 patients met our inclusion criteria; the overall success rate was 87.9% after a mean follow-up of 52.3 ± 18.5 months. Of the patients, 17.6% experienced a 90-day complication. When comparing dorsal and ventral only techniques, there were no significant differences in terms of success rate (88.3% vs. 87.1%, Mantel-Cox test p = 0.68) or postoperative complications (15.5% Vs. 19.4%, p = 0.3). Likewise, there was no significant difference between both techniques regarding postoperative erectile function as assessed by IIEF5-15 score after three months (26.28 ± 2.53 Vs. 26.37 ± 2.41; p = 0.836) and twelve months (26.88 ± 2.45 Vs. 26.48 ± 1.98; p = 0.532). We detected a post-urethroplasty transient ED in (3.9% vs. 1.6%; p = 0.41), and permanent ED in (1.9% vs. 3.2%; p = 0.6) for dorsal and ventral onlay, respectively.

Onlay Buccal mucosa graft urethroplasty is a highly effective surgery in treating long-segment bulbar urethral stricture. The dorsal and ventral only techniques were comparable regarding urinary and erectile function outcomes. Additionally, both techniques have no significant negative impact on post-urethroplasty erectile function status.

World journal of urology. 2022 Dec 02 [Epub ahead of print]

Osama Shalkamy, Adel Elatreisy, Elsayed Salih, Omar Safar, Abdulkareem Aljubran, Tamer A Abouelgreed, Abdulghani Khogeer, Ahmed Ibrahim

Department of Urology, Faculty of Medicine, Al-Azhar University, 1 Al-Mokhaym Al-Daem, Nasr City, 11633, Cairo, Egypt. ., Department of Urology, Faculty of Medicine, Al-Azhar University, 1 Al-Mokhaym Al-Daem, Nasr City, 11633, Cairo, Egypt., Department of Urology, Armed Forces Hospital, Khamis Mushait, Aseer, Kingdom of Saudi Arabia., Department of Surgery, Division of Urology, McGill University Health Center, Montreal, QC, Canada.