Erectile function after different techniques of bulbar urethroplasty: does urethral transection make a difference?

Area of Science:

• Urology
• Surgical Techniques
• Sexual Health

Background:

• Bulbar urethral strictures often require surgical reconstruction via urethroplasty.
• Different urethroplasty techniques exist, with varying impacts on post-operative sexual function.
• Understanding the effect of urethral transection on erectile function is crucial for patient counseling.

Purpose of the Study:

• To compare the impact of urethral transection during bulbar urethroplasty on erectile function outcomes.
• To evaluate the incidence of transient and de novo permanent erectile dysfunction (ED) after different urethroplasty techniques.

Main Methods:

• Retrospective review of 245 patients undergoing bulbar urethroplasty between 2013 and 2021.
• Comparison of transecting versus non-transecting urethroplasty techniques.
• Assessment of erectile function using the IIEF5-15 score pre-operatively and at 3 and 12 months post-surgery; ED defined as a ≥5-point decrease.

Main Results:

• Overall urethroplasty success rate was 86.9% with a mean follow-up of 45.59 months.
• No significant difference in success rates (87.8% vs. 86.5%) or complications (8.1% vs. 7%) between transecting and non-transecting groups.
• Transient ED was more common in the transecting group (8.1% vs. 2.9%), but de novo permanent ED was comparable (4.1% vs. 2.9%).

Conclusions:

• Transecting bulbar urethroplasty techniques may lead to transient erectile dysfunction, often improving within the first year.
• De novo permanent erectile dysfunction is uncommon following various bulbar urethroplasty techniques.
• Urethral transection does not appear to predispose patients to de novo permanent erectile dysfunction.