Comparison of postoperative outcomes related to ejaculatory function and post-micturition dribbling between bulbospongiosus muscle sparing and non-sparing anastomotic urethroplasty techniques

The bulbospongiosus muscle is located in perineum and acts on the propulsion of urine on micturition and sperm on ejaculation. The aim of this study was to compare the outcomes of excision and primary anastomotic urethroplasty (EPA) with and without bulbospongiosus muscle sparing related to ejaculatory function and post-micturition dribbling postoperatively. In the methods, this was a prospective interventional study. Seventy patients with bulbar urethral stricture who underwent EPA in a single institution were included in the present study after having signed the informed consent form. Patients were divided in a single-blind and random manner into 2 groups: 35 underwent bulbospongiosus muscle sparing technique and 35 non-muscle sparing. Preoperative and postoperative (after 3-15 months) ejaculatory function was assessed using the 4 ejaculatory questions of Male Sexual Health Questionnaire Short Form (MSHQ-EjD-SF) and post-micturition dribbling by patient-reported outcome measure (PROM) questionnaire for urethral stricture surgery. In the results, in the preoperative evaluation, mean score of MSHQ-EjD-SF showed no statistically significant difference between the 2 groups compared (p = 0.87) and no patient included in this study had post-micturition dribbling. The mean age of patients was 61.47 years (± 10.41). The mean length of urethral stricture was 1.97 cm (± 0.27). The mean follow-up was 18.7 months (± 2.91). The overall surgical success rate in this study was 95.7% (67/70). There was a decrease in mean score of MSHQ-EjD-SF 3 to 15 months after the urethroplasty compared to the preoperative period in the 2 groups of patients studied. The mean decrease in MSHQ-EjD-SF score was of 0.59 (± 0.10) in patients with bulbospongiosus muscle sparing and 0.67 (± 0.12) in patients without sparing. However, this decrease did not show any statistically significant difference within each group (p = 0.52 for the muscle-sparing group and p = 0.55 for the non-muscle-sparing group) nor between the 2 groups compared (p = 0.72). There was also no statistically significant difference between the groups regarding post-void dribbling, with 1 patient in the sparing group and 2 in the non-sparing group reporting this complication (p = 0.64). In conclusion, the alternative technique of bulbospongiosus muscle sparing in EPA urethroplasty does not seem to improve the outcomes related to ejaculatory function and post-micturition dribbling postoperatively. This suggests that the division of bulbospongiosus muscle in midline in the standard non-muscle-sparing technique would not lead to significant damage to muscle innervation and vascularization than in the alternative muscle-sparing technique.