Nontransecting Techniques Reduce Sexual Dysfunction after Anastomotic Bulbar Urethroplasty: Results of a Multi-Institutional Comparative Analysis

Abstract Purpose The purpose of this multi-institutional study is to compare outcomes of transecting and non-transecting anastomotic bulbar urethroplasty. Materials and Methods This was a retrospective multi-institutional review of 352 patients undergoing either transecting or non-transecting anastomotic bulbar urethroplasty performed by one of four reconstructive urologists from September 2003 to March 2017. Study outcomes were urethroplasty success (defined as urethral patency >16Fr on cystoscopy), de novo sexual dysfunction assessed at 6-months (defined as ≥5-point change in SHIM or patient reported adverse change) and 90-day complications (Clavien ≥2). Comparison between transecting and non-transecting cohorts were made using the Mantel–Cox test, t-test or Chi-square when appropriate. Results 352 patients with a mean stricture length of 1.7cm (0.5-5cm) underwent either a transecting (n=258) or non-transecting (n=94) anastomotic bulbar urethroplasty. Overall success was 94.9% at a mean follow-up of 64.2 months (6-170). 7.1% of patients experienced a 90-day complication and 11.6% reported sexual dysfunction. When comparing transecting and non-transecting techniques there was no difference in success (93.8% vs. 97.9%; p=0.18) (Mantel-Cox) or postoperative complications (8.1% vs. 4.3%; p=0.25). Patients undergoing transecting anastomotic urethroplasty were more likely to report an adverse change in sexual function (14.3% vs. 4.3%; p=0.008). On multivariate analysis, only transecting urethroplasty (p=0.01) was associated with sexual dysfunction while age (p=0.29), stricture length (p=0.42), etiology (p=0.99) and surgeon (p=0.88) were not. Conclusions Anastomotic urethroplasty is a highly effective surgery with relatively minimal associated morbidity. Non-transecting anastomotic urethroplasty compares quite favorably to the transecting technique and likely reduces the risk of associated sexual dysfunction.