Comparison of Sexual Dysfunction Between End-to-End Anastomosis and Buccal Mucosa Graft

Abstract

Objective: The aim of this study was to compare long term follow-up of sexual dysfunction between end-to-end anastomosis or buccal mucosa graft in short segment bulbar urethral stricture. Material & Method: We performed a meta analysis of cohort study. The data sources was MEDLINE from 1980 through 2011. A fixed effects model with Mantel-Haenszel method was used to calculate the pooled Risk Ratio (RRs) and 95% Confidence Interval (CIs). We assessed the heterogeneity by calculating the I2 statistic. All analyses were performed with Stata statistical software, version 10.0 (Stata Corp). Results: We analyzed 6 cohort studies. End-to-end anastomosis and buccal mucosa graft patients who complained about sexual dysfunction were 24.6% (45/183) and 9.1% (11/122) respectively, with overall RR 2.54 (95% CI, 0.22-0.69, p = 0.001). Conclusion: Buccal mucosa graft showed a superior outcome compared to end-to-end anastomosis, based on sexual dysfunction in ≤ 3 cm bulbar urethral stricture treatments.Keywords: Sexual dysfunction, end-to-end anastomosis, buccal mucosa graft, anterior urethral stricture.

Outcomes of transecting versus non‐transecting urethroplasty for bulbar urethral stricture: a meta‐analysis

“…Yuri et al [37] in a meta-analysis on sexual dysfunction reported results convergent to those from our analysis, with better outcomes in the non-transecting group. However, we excluded five from the six studies appraised in the metaanalysis by Yuri et al [37], as most of them included strictures in different urethral segments and/or post-radiation patients. Moreover, both ED, EjD and penile complications were appraised together.…”

“…Penile complications-such as penile length shortening, penile curvature, cold glans sensation or decreased glans sensitivity-are mostly caused by loss of corpus spongiosum length after excision and by compromised vascular supply [43]. Yuri et al [37] in a meta-analysis on sexual dysfunction reported results convergent to those from our analysis, with better outcomes in the non-transecting group. However, we excluded five from the six studies appraised in the metaanalysis by Yuri et al [37], as most of them included strictures in different urethral segments and/or post-radiation patients.…”

“…Another difference is related to stricture length. Yuri et al [37] restricted inclusion to studies on short strictures (<3 cm), which seems to be methodically more appropriate. However, the authors relied on mean stricture length in each study, whereas stricture length ranged up to 10-11 cm in some of the included studies [38,40] making this difference less pronounced.…”

“…To the best of our knowledge few meta-analyses have been published to date on the same topic. The one conducted by Yuri et al [37] included 10 studies with six of them embracing data on sexual dysfunction and six on stricture recurrence or voiding symptoms. Results regarding stricture recurrence differ substantially from those presented in our present synthesis.…”

“…Results regarding stricture recurrence differ substantially from those presented in our present synthesis. Based on the data from three studies [25,38,39] and a total of 153 patients included, Yuri et al [37] reported a significantly higher stricture recurrence rate following BMG augmentation than EPA (30% vs 8.4%, overall RR 0.38; 95% CI 0.17-0.84; P = 0.016). This was mostly due to study by Lewis et al [38] constituting 81.8% of pooled effect.…”