Upper transverse scrotal approach for muscle- and nerve-sparing urethral stricture repair

De novo erectile dysfunction after anterior urethroplasty: a systematic review and meta-analysis

OBJECTIVE

To evaluate the likelihood of developing de novo erectile dysfunction (ED) after anterior urethroplasty and to determine if this likelihood is influenced by age, stricture length, number of previous procedures or timing of evaluation.

MATERIALS AND METHODS

PubMed, Embase, Cochrane, and Google Scholar databases were searched for the terms 'urethroplasty', 'urethral obstruction', 'urethral stricture', 'sexual function', 'erection', 'erectile function', 'erectile dysfunction', 'impotence' and 'sexual dysfunction'. Two reviewers evaluated articles for inclusion based on predetermined criteria.

RESULTS

In a meta-analysis of 36 studies with a total of 2323 patients, de novo ED was rare, with an incidence of 1%. In studies that assessed postoperative erectile function at more than one time point, ED was transient and resolved at between 6 and 12 months in 86% of cases.

CONCLUSIONS

Men should be counselled regarding the possibility of transient or permanent de novo ED after anterior urethroplasty procedures. Increasing mean age was associated with an increased likelihood of de novo ED, but this was not statistically significant.

Management of anterior urethral stricture: an evidence-based approach

PURPOSE OF REVIEW

To provide a review of the latest evidence on the management of anterior urethral strictures.

RECENT FINDINGS

A continuing role exists for urethrotomy or dilatation in the management of urethral strictures as first-line therapy in selected patients. In those patients with bulbar strictures who fail or are not suitable for these procedures, an anastomotic urethroplasty, and if not feasible a substitution urethroplasty using either a flap or oral mucosal graft either by a dorsal, lateral or ventral onlay approach should be considered. For penile strictures, a ventral onlay procedure using skin can be considered except in cases of lichen sclerosis when an onlay procedure utilizing oral mucosa provides the best results using either a one-stage or two-stage approach.

SUMMARY

Various options exist for the management of anterior urethral stricture disease. The 'reconstructive ladder' has served to guide urologists over the years. The selection of the correct procedure should be patient-centred and based on the latest evidence.