Bulbospongiosus muscle sparing urethroplasty versus standard urethroplasty: A comparative study.

OBJECTIVE: To compare outcome of muscle and nerve-sparing bulbar urethroplasty with standard bulbar urethroplasty as regard ejaculatory dysfunction and post-void dribbling.

METHODS: This prospective randomized study included 50 patients with bulbar urethral stricture underwent urethroplasty over a period of 5y. All patients were operated by ventral onlay buccal mucosal graft urethroplasty and randomly divided into two groups. Group I (n=25) was operated by standard bulbar urethroplasty. Group II (n=25) was operated by bulbar urethroplasty with preservation of bulbospongiosus muscle and nerve. Postoperative follow-up was performed at 1, 6 and 12m and annually thereafter. Urethrography was done at 1m, while uroflowmetry was performed at 6 and 12m. Urethrography was indicated if Qmax <14 ml/sec. Success was defined as normal voiding without any auxiliary procedures.

RESULTS: Success rate was 88% and 92% in Group I and II respectively. Urethral sacculation was not detected in any patient in either group. One patient from Group I was complicated by urinary extravasation after catheter removal and required re-catheterization for another 1w. One patient in each group was complicated by postoperative wound infection managed by antibiotics. Post-void dribbling was the complaint of 9 patients in Group I and one patient in Group II, while semen sequestration was present in 10 and 2 patients in Group I and Group II respectively. Significant differences were observed between the two groups as regard post-void dribbling and ejaculatory dysfunction.

CONCLUSION: Bulbar urethroplasty with bulbospongiosus muscle and nerve-sparing seems to be a safe and effective alternative for standard bulbar urethroplasty.