Long-term outcomes of the excision and primary anastomotic urethroplasty in non-traumatic bulbar and membranous urethral strictures.

PURPOSE: Urethral stricture disease commonly affects the bulbar and membranous urethra. Excision and primary anastomosis techniques (end-to-end bulbar urethral anastomosis and bulboprostatic anastomosis) are widely used for isolated bulbar and bulbomembranous strictures. This study aimed to evaluate the long-term functional outcomes of these excision and primary anastomotic urethroplasty techniques.

METHODS

A retrospective, single-center chart review was conducted on patients who underwent perineal excision and primary anastomotic urethroplasty between 2005 and 2023. Patients with prior pelvic surgery, radiotherapy, hormonal therapy, or inadequate follow-up were excluded. Data on clinical history, surgical details, urethral recurrence, erectile function, and complications were collected. Erectile function was assessed via a patient-reported 4-point scale. Surgical success was defined as no requirement for additional procedures during follow-up.

RESULTS

Of 65 patients initially identified, 45 met the inclusion criteria (end-to-end bulbar urethral anastomosis group: n = 35; bulboprostatic anastomosis group: n = 10). Corporal separation was performed in 8 cases of bulboprostatic anastomosis. Postoperative success rates were 94.2% (end-to-end bulbar urethral anastomosis) and 90% (bulboprostatic anastomosis). De novo erectile dysfunction occurred in 10% of end-to-end bulbar urethral anastomosis cases and 16.7% of bulboprostatic anastomosis cases.

CONCLUSIONS

Both end-to-end bulbar urethral anastomosis and bulboprostatic anastomosis are highly effective for isolated bulbar and bulbomembranous urethral strictures, with excellent success rates and low complication profiles. Erectile function was preserved mainly, although ancillary maneuvers, such as corporal separation, were associated with higher erectile dysfunction rates. These findings support the careful selection and planning of excision and primary anastomotic techniques to optimize both functional and surgical outcomes.