Single-surgeon experience of excision and primary anastomosis for bulbar urethral stricture: analysis of surgical and patient-reported outcomes

Purpose To report our experience with excision and primary anastomosis (EPA) for bulbar urethral stricture. Methods Patients who underwent EPA for bulbar stricture between 2012 and 2019 were retrospectively analyzed (n = 308). Successful urethroplasty was defined as the absence of the need for additional treatment. For follow-up, uroflowmetry was performed and the patients completed the validated Urethral Stricture Surgery Patient-reported Outcome Measure and Sexual Health Inventory for Men (SHIM) questionnaires before (baseline) and 6 months after EPA. Overall patient satisfaction after urethroplasty was also evaluated. Results Urethroplasty was successful in 97.1% of patients (n = 299) with a median follow-up of 37 months. A total of 215 patients (69.8%) completed the questionnaires at 6 months postoperatively. The mean maximum flow rate, lower urinary tract symptom (LUTS)-total score, Peeling's picture score, LUTS-specific quality of life, and EuroQol-visual analog scale scores improved significantly from 7.7 ml/s, 11.6, 3.3, 2.4, and 58.0 at baseline to 24.1 ml/s, 2.7, 1.9, 0.4, and 82.1 postoperatively (p < 0.0001 for all comparisons). However, five-point or greater deterioration in the SHIM score was found in 41 patients (19.1%). Regarding patient satisfaction, 98.6% of patients (212/215) were satisfied (32.6%) or very satisfied (66.0%) with the outcome. A low postoperative LUTS-total score and Peeling's picture score were independent predictors of a very satisfied patient (p = 0.001 and p = 0.01, respectively). Conclusions EPA had a high success rate and was associated with significant benefits in both subjective and objective outcomes. Contrarily, a high incidence of postoperative erectile dysfunction was observed.

Automated summary

Excision and primary anastomosis (EPA) for bulbar urethral stricture showed a high success rate, with significant improvements in postoperative maximum flow rate, lower urinary tract symptom scores, and quality of life. However, a notable incidence of postoperative erectile dysfunction was observed. Overall, the majority of patients were satisfied or very satisfied with the surgical outcome.