Sexual function after reconstructive surgery for anterior urethral stricture disease

There are few studies that address the subject of sexual function after reconstructive surgery for anterior urethral stricture disease.

In an effort to better define sexual dysfunction after urethroplasty for anterior strictures, a recent study was performed by Chris Gonzalez and colleagues from Northwestern University in Chicago. The paper is published in the March 2007 issue of BJU International.

The study group was composed of 52 men with a median age of 44 years who underwent 59 urethral reconstructive procedures for anterior urethral stricture disease between 2001 and 2004. Sexual function was assessed using the O'Leary Brief Male Sexual Function Survey (OBSFI) before and after surgery. The mean follow-up was 22.3 months.

The operations performed included bulbar excision and primary anastomosis (EPA; 23 of 52, 44%), dorsal or ventral buccal mucosa onlay reconstructions (22 of 52, 42%), and two-stage repairs using buccal mucosa (7 of 52, 14%). The mean stricture length was 4.85 cm.

Analysis of the sexual function scores revealed that there were no significant differences in the mean scores within the sexual drive and erectile function domains before and after surgery. It did appear that those patients that had at least 12 months of recovery after their urethroplasties had a better chance of achieving an improved status. In the ejaculatory function domain, there was a significant increase in the overall EjF score after surgery as a whole and the improvement was the most robust in men < 49 years old. This result can be expected partly because of the absence of obstruction but some authors, such as Guido Barbagli, have postulated that some aspect of post-void dribble and EjD can be expected after this surgery due to disruption of the bulbospongiosum expulsion mechanism due to the separation of these muscle fibers during reconstruction.

Bradley A. Erickson, James S. Wysock, Kevin T. McVary and Christopher M. Gonzalez

BJU Int. 2007 Mar; 99(3): 607-11

By Michael J. Metro MD