Prospective Assessment of Patient-perceived Short-term Changes in Penile Appearance After Urethroplasty

To define the incidence and associations of patient-reported penile curvature and shortening after urethroplasty. Alterations in penile curvature or length post-urethroplasty are associated with patient dissatisfaction but are poorly described.

From 2011 to 2019, 387 patients completed enrollment in a prospective single-centre study assessing patient-reported outcomes pre-operatively and 6-months post-urethroplasty. Primary outcomes of perceived penile shortening and curvature were assessed at 6-months follow-up. Descriptive statistics were used to summarize findings while univariate and multivariate binary logistic regression was used to identify associations between loss of penile length or chordee with other clinical factors.

Of the 387 patients, mean age was 49.5 years with mean stricture length of 4.5 cm. Postoperatively, 12.7% of patients perceived penile curvature (8.0% "somewhat", 4.7% "severe") and 22.8% of patients perceived penile shortening (14.5% "somewhat", 8.3% "a lot"). Multivariate binary logistic regression identified stricture location (P = .02) to be associated with perceived curvature while prior urethroplasty (P = .17), type of urethroplasty (P = .08) and other factors were not. Specifically, penile (O.R. 4.27, 95%CI 1.56-11.68, P = .005) and panurethral (O.R. 10.15, 95%CI 3.46-29.77, P <.001) locations were independently associated with this outcome. In a multivariate model, panurethral strictures (O.R. 4.23, 95%CI 1.10-16.20, P = .04) and hypospadias (O.R. 5.46, 95%CI 1.32-22.70, P = .02) were associated with patient perceived shortening while other factors such as age (P = .19), type of urethroplasty (P = .14) and other etiologies or locations were not.

Clinically significant changes in penile appearance are more common post-urethroplasty than generally thought. Stricture location and etiology are important predictors of these patient-perceived changes.