The effect of dorsal onlay buccal mucosal graft urethroplasty on erectile and ejaculatory functions: a single-center observational study

To examine the effects of dorsal onlay buccal mucosal graft (BMG) urethroplasty on sexual function by considering stricture parameters such as location, length and patient parameter such as age. This ambispective observational study was conducted at a tertiary referral center involving 42 sexually active men who underwent dorsal onlay BMG urethroplasty for short-segment distal bulbar urethral strictures (≤ 3 cm) between August 2023 and January 2025. Patients were categorized according to age (< 50 or ≥ 50 years) and stricture length (≤ 2 cm / 2–3 cm). Before the urethroplasty operation and at postoperative sixth- and twelfth-month follow-ups, the International Index of Erectile Function (IIEF-15) and Male Sexual Health Questionnaire–Ejaculatory Dysfunction Short Form (MSHQ-EjD-SF) were filled. Relevant domains of sexual function, erectile function, orgasmic function, sexual satisfaction, and ejaculatory function were assessed. The mean age of the cases was 46.8 ± 11.2 years. Mean erectile function (IIEF-EF) scores demonstrated a transient decline at 6 months (24.1 ± 3.6 vs. 21.3 ± 4.1; p = 0.004) but recovered to baseline levels by 12 months (23.7 ± 3.8; p = 0.58). Ejaculatory function scores (MSHQ-EjD-SF) remained stable throughout the follow-up period (p = 0.11). While patients aged ≥ 50 years had lower baseline sexual function scores than younger patients (p = 0.01), they exhibited similar recovery patterns. Stricture length > 2 cm did not significantly predict postoperative sexual dysfunction (p > 0.05). Our study suggests that dorsal onlay BMG urethroplasty has no significant long-term deterioration in erectile function, ejaculatory function, and general sexual satisfaction was observed. However, transient decline in erectile function may occur in the early postoperative period.