Abstract: PD34-04
Sources of Funding: none

Introduction

We report the short and long term results and sexual side effects of dorsal-ventral buccal graft urethroplasty (dorsal approach) for the 1 stage repair of long obliterative/near-obliterative anterior urethral strictures.

Methods

We reviewed our prospectively maintained database. Only patients who underwent cystoscopy (4 months after surgery) and completed validated questionnaires in 2016 were included. Technical success was defined by a minimum urethral caliber of >16 French 4 months after surgery. Questionnaires included International Prostate Symptom Score (IPSS), Sexual Health Inventory for Men (SHIM), Male Sexual Health Questionnaire Ejaculatory Dysfunction Short Form (MSHQ-EjD-SF), and urethroplasty specific patient reported outcome measures (PROMs). A Wilcoxon signed-rank test was used to evaluate change in mean IPSS.

Results

We identified 26 patients, and 3 were excluded for lacking cystoscopy or questionnaire. Mean age at time of surgery was 54 years (19-77). Mean follow-up was 60 months (4-210). All patients had a history of prior urethral surgery or self-catheterization, 70% with multiple procedures. Ten patients (43%) had prior open urethral reconstruction, including 7 with tissue transfer. Single buccal mucosal graft was used in 30%, bilateral in 70%, and a third lower lip graft in 9%. The 4-month technical success rate was 87%. The success rates for those with and without prior open reconstruction were 90% and 85%, respectively. Two of the 3 failures (defined by urethral caliber slightly < 16 French) would be considered successfully repaired by less stringent criteria (providing a 95.6% success rate) as they required no additional procedures and were &[Prime]very satisfied&[Prime] with IPSS of 2 and 3. There was no significant change in mean IPSS from postoperative cystoscopy to last follow up (5.2 to 5.9, p=0.46). In 2016, the mean SHIM and MSHQ-EjD-SF scores were 14 and 8, respectively. Regarding patient satisfaction, 74% are very satisfied, 17% are satisfied, and 9% are unsatisfied.

Conclusions

The dorsal and ventral buccal graft repair via dorsal approach, a 1-stage non-transecting technique of circumferential substitution urethroplasty, is associated with a high patient satisfaction, and validated questionnaires demonstrate lasting results.

Funding

none