Comparison of Functional and Patient-reported Outcomes Following Non-transecting Anastomotic Urethroplasty for Lengthy (>2 cm) Versus Short (≤2 cm) Bulbar Urethral Strictures.

OBJECTIVE

To compare functional success and patient-reported outcomes measures (PROM) after non-transecting anastomotic urethroplasty (NTAU) for management of lengthy (>2 cm) and short (≤2 cm) bulbar urethral strictures.

METHODS

Patients undergoing NTAU for bulbar urethral strictures by a single surgeon from 2017 to 2024 were retrospectively reviewed. Urethral stricture recurrence was defined as need for repeat intervention. Stretched penile length (SPL) was collected pre- and post-operatively. A survey that comprised urinary and sexual patient-reported outcome measures (PROMs) was collected. Outcomes were compared based on stricture length (>2 cm vs ≤2 cm) and location within the bulbar urethra (mid/proximal versus distal).

RESULTS

A total of 97 patients underwent NTAU for bulbar strictures [88% mid/proximal (n = 85), 12% distal (n = 12)] with a median stricture length of 1.7 (1-2.5) cm. One-third (32/97) had lengthy (>2 cm) strictures. Overall functional success was 96% at a median follow-up of 8.4 (3.5-15.8) months: 94% lengthy (30/32), 97% short (63/65). Survey response was 53% (51/97). There was no significant difference in 30-day complications (9% vs 12%) or anastomotic leak on VCUG (9% vs 3%) between lengthy and short strictures (all P>.05). Lengthy strictures were associated with a greater reduction in SPL compared to short strictures (-4% vs 0%; P=.001). There was no significant difference in PROMs between groups, however, distal patients reported more angulation (57% vs 12%, P=.02) and subjective penile length loss (86% vs 38%, P=.04) postoperatively.

CONCLUSION

NTAU is an effective option for lengthy (>2 cm) bulbar urethral strictures with high functional success and comparable postoperative sexual side effects observed with short strictures. Patients with distal strictures should be counseled regarding increased incidence of penile related side-effects such as angulation and perceived penile length loss.