Abstract: PD63-12
Sources of Funding: none

Introduction

Anastomotic urethroplasty has long been recognized as a reliable method of reconstruction for focal, severe bulbar urethral strictures. The role of excision and primary anastomosis (EPA) is less well defined for penile urethral strictures due to concerns for potential compromise of sexual function. We report a multi-institutional experience with functional outcomes among men undergoing EPA of pendulous urethral strictures.

Methods

A retrospective review was conducted of over 2000 urethroplasty patients from two tertiary referral centers from 1995-2016. We identified 13 men treated with EPA for isolated penile urethral strictures, with radiographically confirmed location between the penoscrotal junction and urethral meatus. Clinical characteristics and outcomes are described. Validated questionnaires were utilized to evaluate overall improvement (PGI-I), urinary bother (I-PSS), sexual function (IIEF-5), as well as symptoms related to penile curvature (PDQ).

Results

Among the 13 men who underwent EPA for penile urethral strictures, strictures were focal (median length 1cm, IQR 1-1.4) and median follow-up was 31 months (IQR 5-110). Only 1/12 (8%) men experienced a treatment failure requiring further instrumentation. None reported new onset penile curvature or curvature related bother (PDQ) following treatment. The majority of men had stricture etiology reported as trauma (10/13, 77%), of which 4 had a history of urethral disruption secondary to penile fracture and 6 iatrogenic trauma. Median patient age was 51 years (IQR 30-60); and 8/12 (67%) had normal preoperative erectile function. After stricture treatment, 75% of men reported a significant global improvement in condition (PGI-I). Sexually active men reported normal erectile function (median IIEF 21 (IQR 19-25), and the majority had only mild urinary bother (median IPSS 4 (IQR 2-14)). The single treatment failure had a history of hypospadias with multiple prior procedures who now requires intermittent catheterization.

Conclusions

Among selected patients with focal traumatic strictures involving the penile urethra, EPA appears to be highly effective with negligible impairment of erectile function.

Funding

none