MP52-08 EXCISION AND PRIMARY ANASTOMOSIS VS. DORSAL BUCCAL GRAFTING FOR BULBAR URETHRAL STRICTURES: COMPARISON OF OUTCOMES AND QUALITY OF LIFE

AND OBJECTIVES: Excision and primary anastomosis (EPA) with urethral transection has historically been favored as the procedure of choice for short bulbar urethral strictures due to excellent success rates. However, buccal graft onlay repair without transection is gaining favor because of potential long-term sexual complications that may result from EPA. We aim to compare short and long-term urinary and sexual outcomes of both procedures. METHODS: A retrospective analysis was performed of all EPA and dorsal buccal (DB) urethroplasties performed for bulbar urethral strictures at our institution between 1998 and 2015. Exclusion criteria included prior urethroplasty, simultaneous reconstruction of a separate part of the urethra, need for a 2nd buccal graft harvest, hypospadias or lichen sclerosis. Our protocol includes cystoscopy 4 months after surgery to ensure a technical success and subsequent annual symptom, flow rate, and post-void residual assessment. All patients included in the study who were contacted during the month prior to abstract submission completed validated questionnaires to assess voiding, erectile, and ejaculatory function and other urethroplasty specific outcomes including glans sensitivity and engorgement. RESULTS: After exclusion criteria were applied, a total of 130 (EPA) and 38 (DB) patients were included in the study. Technical success at 4 months, success at last evaluation, length of stricture and length of follow-up for EPA vs DB was 100% vs. 97.4% (NS), 99.2% vs. 94.7% (p1⁄40.07), 1.7cm vs. 3.95cm (p<0.0001) and 42.3 vs. 39.8 months respectively. Thirty-one EPA and twenty-one DB patients responded to the survey. Of these, ejaculatory bother and post-void dribbling were significantly worse in the DB group. Six patients in the EPA group complained of a pulling sensation or curvature during erection compared to one in the DB group (p1⁄40.21, the average stricture length was 1.4 cm in this group). DB grafting was associated with worse pot-void dribbling and ejaculatory bother. There were otherwise no significant differences in patient reported outcome measures related to quality of life, urinary function, erectile function, sexual activity, or penile sensitivity between groups. No patients complained of a cold glans. CONCLUSIONS: EPA and DB grafting are both highly successful techniques for strictures isolated to the bulbar urethra with low sexual complications. Our data does not suggest that EPA for short bulbar strictures should be avoided in favor of DB due to a concern of an increased risk of sexual side effects with EPA.