Vol. 6, Issue 1, Part C (2024)

Urethroplasty is the established gold standard for treating urethral stricture disease, but postoperative erectile dysfunction (ED) poses a significant concern, especially in cases of bulbar urethroplasty due to the proximity of critical erectile structures. This study aimed to compare the impact of anastomotic urethroplasty (AU) and substitutional urethroplasty (SU) on erectile function for bulbar urethral stricture. This quasi-experimental study was conducted at the Department of Urology, Dhaka Medical College Hospital (DMCH) for a period from March 2021 to August 2022. Total 64 patients (32 patients in each group) fulfilled the selection criteria and hence they were recruited in this study by using purposive sampling. Data were analyzed by using SPSS Version 22.0. This study illustrated that similar mean ages in the AU (38.70±6.60 years) and SU (38.33±6.99 years) groups. The preoperative stricture lengths were comparable between the groups (AU: 2.41±0.26 cm; SU: 2.53±0.34 cm, P=0.129), and body mass index (BMI) did not differ significantly (P=0.950). Erectile function was assessed using the International Index of Erectile Function-5 (IIEF-5) questionnaire and penile duplex ultrasonography at preoperative, 3-month, and 6-month postoperative intervals. Preoperative IIEF-5 scores showed no significant difference (AU: 22.87±0.68; SU: 23.60±0.72; P=0.112). At the 3-month follow-up, AU patients experienced a significant decline in IIEF-5 scores (19.83±6.38) compared to SU patients (22.80±2.31, P=0.020), with 23.33% reporting ED in the AU group versus 6.66% in the SU group. However, by 6 months, most patients in both groups exhibited recovery, and differences were not statistically significant (AU: 21.83±4.20; SU: 23.43±1.28, (P=0.051). Importantly, penile duplex ultrasonography revealed no vascular abnormalities, indicating that ED was likely due to nerve impact or inflammation. The study concludes that AU is associated with a higher initial incidence of ED compared to SU, but erectile function stabilizes over time. The study underscores the need for surgical approaches that minimize nerve damage to reduce postoperative ED risk.