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. 2019 Jan 23:2019:7826085.
doi: 10.1155/2019/7826085. eCollection 2019.

Excision and Primary Anastomosis for Bulbar Urethral Strictures Improves Functional Outcomes and Quality of Life: A Prospective Analysis from a Single Centre

Pieter D'hulst  1 , Michael S Floyd Jr  1 , Fabio Castiglione  1 , Kathy Vander Eeckt  1 , Steven Joniau  1 , Frank Van der Aa  1
Affiliations

Excision and Primary Anastomosis for Bulbar Urethral Strictures Improves Functional Outcomes and Quality of Life: A Prospective Analysis from a Single Centre

Pieter D'hulst et al. Biomed Res Int. .

Abstract

Background: Excision and primary anastomotic (EPA) urethroplasty remains the gold standard definitive treatment for short urethral stricture disease. For patients, postoperative erectile function and quality of life are the main goals of the surgery. Patient-reported outcome measures (PROMs) are therefore of major importance.

Objective: The objective of this study was to prospectively analyse functional outcomes and patient satisfaction.

Design settings and participants: We prospectively evaluated 47 patients before and after EPA from August 2009 until February 2017. The first follow-up visit occurred after a median of 2.2 months (n = 47/47), with the second and third follow-ups occurring at a median of 8.5 months (n = 38/47) and 20.2 months (n = 31/47). Before surgery and at each follow-up visit, the patients received five questionnaires: the International Prostate Symptom Score (IPSS), the International Prostate Symptom Score with the Quality of Life (IPSS-QOL) score, the Urogenital Distress Inventory Short Form (UDI-6) score, the International Index of Erectile Function-5 (IIEF-5) score, and the ICIQ-Lower Urinary Tract Symptoms Quality of Life (ICIQ-LUTS-QOL) score.

Surgical procedure: Surgery was performed in all cases using the same standardized EPA technique.

Outcome measurements and statistical analysis: Voiding symptoms, erectile dysfunction, and quality of life were analysed using paired sample t-tests, with a multiple-testing Bonferroni correction. Any requirement for instrumentation after surgery was considered treatment failure.

Results and limitations: Patients with mild or no baseline erectile dysfunction showed significant decline in erectile function at first follow-up (mean IIEF-5 of 23.27 [standard deviation; SD: 2.60] vs. 13.91 [SD: 7.50]; p=0.002), but this had recovered completely at the third follow-up (IIEF-5: 23.25 [SD: 1.91]; p=0.659). Clinically significant improvements were noted in IPSS, IPSS-QOL-score, UDI-6-score, and ICIQ-LUTS-QOL-score at the first follow-up (p<0.0001). These improvements remained significant at the second and third follow-ups (p<0.0001) for all PROMs. Three of the patients experienced stricture recurrence. The main limitations of this study were incomplete questionnaires, loss to follow-up, and low number of patients.

Conclusions: EPA results in an initial decline in erectile function, but full recovery occurred at a median of 20 months. Voiding improved significantly, and a major improvement in quality of life was noted, which persisted for up to 20 months after surgery.

Patient summary: This study showed the importance of patient-reported outcome measures in indicating the actual outcome of urethral stricture disease surgery.

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Figures

Figure 1
Figure 1
Flowchart and study design. IQR: interquartile range, IPSS: International Prostate Symptom Score, IPSS-QOL: International Prostate Symptom Score with Quality of Life, UDI-6: Urogenital Distress Inventory Short Form score, IIEF-5: International Index of Erectile Function-5 score, and ICIQ-LUTS-QOL: ICIQ-Lower Urinary Tract Symptoms Quality of Life score.
Figure 2
Figure 2
Kaplan-Meier statistical analysis curve. EPA: excision and primary anastomosis.
Figure 3
Figure 3
Comparison of the mean preoperative IPSS with the IPSS at the first, second, and third follow-up visits.
Figure 4
Figure 4
Comparison of the mean preoperative UDI-6 score with the UDI-6 scores at the first, second, and third follow-up visits.
Figure 5
Figure 5
Comparison of the mean preoperative IIEF-5 score with the IIEF-5 scores at the first, second, and third follow-up visits in patients with mild-to-no erectile dysfunction at baseline.
Figure 6
Figure 6
Comparison of the mean preoperative IIEF-5 score with the IIEF-5 scores at the first, second, and third follow-up visits in patients with moderate-to-severe erectile dysfunction at baseline.
Figure 7
Figure 7
Comparison of the mean preoperative IPSS-QOL score with IPSS-QOL scores at the first, second, and third follow-up visits.
Figure 8
Figure 8
Comparison of the mean preoperative ICIQ-LUTS-QOL score with ICIQ-LUTS-QOL scores at the first, second, and third follow-up visits.
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