Bulbospongiosus Muscle Sparing Urethroplasty Versus Standard Urethroplasty: A Comparative Study

To compare outcome of muscle and nerve-sparing bulbar urethroplasty with standard bulbar urethroplasty as regard ejaculatory dysfunction and postvoid dribbling.

This prospective randomized study included 50 patients with bulbar urethral stricture underwent urethroplasty over a period of 5 year. All patients were operated by ventral onlay buccal mucosal graft urethroplasty and randomly divided into 2 groups. Group I (n = 25) was operated by standard bulbar urethroplasty. Group II (n = 25) was operated by bulbar urethroplasty with preservation of bulbospongiosus muscle and nerve. Postoperative follow-up was performed at 1-, 6-, and 12-month and annually thereafter. Urethrography was done at 1-month, while uroflowmetry was performed at 6- and 12-month. Urethrography was indicated if Q_max <14 mL/sec. Success was defined as normal voiding without any auxiliary procedures.

Success rate was 88% and 92% in Group I and II, respectively. Urethral sacculation was not detected in any patient in either group. One patient from Group I was complicated by urinary extravasation after catheter removal and required re-catheterization for another 1week. One patient in each group was complicated by postoperative wound infection managed by antibiotics. Postvoid dribbling was the complaint of 9 patients in Group I and 1 patient in Group II, while semen sequestration was present in 10 and 2 patients in Group I and Group II, respectively. Significant differences were observed between the 2 groups as regard postvoid dribbling and ejaculatory dysfunction.

Bulbar urethroplasty with bulbospongiosus muscle and nerve-sparing seems to be a safe and effective alternative for standard bulbar urethroplasty.