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Critical Analysis of Bulbospongiosus sparing bulbar urethroplasty on ejaculatory function and post-void dribbling
Ariel Fredrick, MD1, Bradley Erickson, MD2, Kristian Stensland, MD1, Alex Vanni, MD1.
1Lahey Hospital and Medical Center, Burlington, MA, USA, 2University of Iowa College of Medicine, Iowa City, IA, USA.

BACKGROUND:
Traditional bulbar urethroplasty techniques call for splitting of the bulbospongiosus muscle to gain access to the strictured segment of urethra. Bulbar urethroplasty outcomes studies have shown low but significant rates of post-void dribbling (PVD) and ejaculatory dysfunction, and because the bulbospongiosus muscle is involved with expulsion of seminal fluid and urine from the bulbar urethra, we hypothesized that performing urethroplasty utilizing a technique that does not split the muscle may result in better post-operative patient reported ejaculatory function (EF) and less PVD.
METHODS:
Beginning in 2014 a bulbospongiosus sparing (BS) technique was implemented in all primary bulbar urethroplasties by two surgeons from different academic institutions. To analyze the effectiveness of BS on preservation of EF and avoidance of PVD, we performed a matched, case-control analysis comparing men who underwent the BS technique to men that had undergone the traditional non-bulbospongiosus sparing (NBS) immediately before the switch in technique was made. Pre- and post-operatively (3-12 months) EF was assessed using the 4 ejaculatory questions of the Male Sexual Health Questionnaire (MSHQ) short form, as well as with a patient perception questionnaire. Post-void dribbling was assessed using a validated urethroplasty questionnaire.
RESULTS:
We compared 16 BS and 16 NBS patients that were matched by total pre-operative MSHQ score, age and performance of EPA. Median timeof post-operative questionnaire completion was 4.26 months, which was similar between the two groups (p = 0.76). Comorbidity rates and stricture length were similar between each group. BS and NBS groups had similar post-operative total MSHQ scores (14.25 vs. 15.06 respectively, p=0.53) and there were no significant post-operative MSHQ changes in either group (BS; 14.25 to 14.69, p=0.65; NBS; 13.37 vs. 15.81, p=0.59). Individual MSHQ questions were analyzed between groups and not found to have a statistically significant difference. Rates of post-operative PVD and perception of EF were similar between the two groups (table).
CONCLUSIONS:
Sparing the bulbospongiosus muscle during urethroplasty does not seem to have a significant impact on patient reported EF or PVD compared with non-bulbospongiosus sparing urethroplasty at early follow-up.


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