Traumatic Bulbar Urethral Stricture: Improvised Reconstruction with Muscle and Nerve Sparing Approach

Abstract

Introduction: Anastomotic urethroplasty in traumatic bulbar stricture is successful in 90-95% of cases, but for post-void dribble and ejaculatory dysfunction (EjD). Here, we present modified muscle and nerve-sparing urethroplasty to overcome these problems. Material and Methodology: A retrospective analysis (from January 2015- January 2019) of 55 patients with traumatic bulbar stricture managed by standard urethroplasty (Group 1, N=30) and modified urethroplasty (Group2, N=25) was done. The comparison also included their post-operative EjD and post-void dribble. Results: Mean age of patients was 31.12 (15-55) years. Mean length of stricture was 1.41 [1-2] cm. Mean Qmax was 27.8 and 26.4ml/s in the modified and standard urethroplasty group (P-value>0.05). EjD was calculated for each patient using questions from male sexual health questionnaire (MSHQ)and MSHQ mean scores pertaining to ejaculation had a significant difference between Group1 and Group2 with mean post- operative scores of 14.17 and 21.12 respectively (p-value- <0.005) At 1-year, ten patients (33%) from Group 1 while one patient (4%) in the Group 2 showed post-void dribbling respectively (P-value-0.007). Discussion: Success rate (patient not needing post-operative intervention) was 100% in modified and 96.66% in standard urethroplasty group. Results in terms of EjD and post-void dribble were statistically significant. Conclusion: In traumatic bulbar stricture, muscle and nerve-sparing urethroplasty is associated with statistically significant better outcomes in terms of EjD and post-void dribble.