Presentation Authors: Jordan Bekkema*, Keith Rourke, Edmonton, Canada
Introduction: While urethroplasty is the most effective treatment for urethral stricture, the majority of outcomes are reported from a surgeon perspective and there is limited data describing patient reported outcomes after urethroplasty. Our objective is to comprehensively describe patient reported outcomes after urethroplasty.
Methods: 357 patients from 2011-2018 were enrolled in a prospective single-center study comprehensively assessing patient reported outcomes after urethroplasty including satisfaction, urinary function, quality of life, erectile function, ejaculatory function, penile appearance/curvature, genitourinary pain, and post-void dribbling. Patient satisfaction was determined using a 5-point Likert scale. Voiding function was assessed with the International Prostate Symptom Score (IPSS). Erectile function was assessment with the International Index of Erectile Function 5 (IIEF-5) and erectile dysfunction was defined as a â‰¥5-point change in IIEF-5. Ejaculatory function was scored using a hybrid of the ejaculatory component of the brief sexual function inventory. The remaining measures were assessed using literature derived 3 or 5 point Likert scales. Descriptive statistics were used to summarize findings while both parametric (paired t-test, Chi-square) and non-parametric (Wilcoxon) tests were used to compare pre- and post-operative findings.
Results: Of the 357 patients enrolled, mean age was 49.7 years with a mean stricture length of 4.4cm. Stricture location was most commonly bulbar (59.7%) followed by penile (19.9%) and posterior (13.7%). The most common stricture etiology was idiopathic (40.3%), iatrogenic (14.0%), trauma (13.2%) or lichen sclerosus (12.3%). Patients underwent a variety of urethroplasty techniques, including buccal mucosa graft onlay (42.6%), anastomotic (30.0%) or staged (11.2%) reconstruction. 92.0% of patients were stricture free on follow-up cystoscopy and 80.0% of patients reported being satisfied with the results of surgery while 7.3% of patients were unsatisfied. Voiding function was globally improved after urethroplasty including urinary quality of life (4.7 vs. 1.6; p < 0.0001), IPSS (19.3 vs. 6.0; p < 0.0001), post-void dribbling (2.7 vs. 2.5; p=0.04) and sitting to void (2.4 vs. 1.9; p < 0.0001). Additionally, genitourinary pain scores improved postoperatively (2.2 vs. 1.6; p < 0.0001). Overall, erectile function remained unchanged (17.7 vs. 17.2; p=0.46) but 12.0% of patients reported new onset erectile dysfunction. The incidence of ejaculatory function remained unchanged (p=0.13) but 7.1% of patients reported worsening of ejaculatory function postoperatively. The majority of patients reported minimal change in penile length or curvature but 6.7% and 3.1% of patients complained of bothersome loss of penile length or curvature respectively.
Conclusions: Urethroplasty globally improves voiding function and genitourinary pain associated with urethral stricture. While sexual function is preserved for the majority of patients, a small proportion of patients describe new onset erectile dysfunction, penile shortening or curvature and should be counselled accordingly.
Source of Funding: University of Alberta Department of Surgery Summer Studentship, Northern Alberta Urology Foundation