title: Long-term followup of bulbar end-to-end anastomosis: a retrospective analysis of 153 patients in a single center experience.
abstract: OBJECTIVE
  We performed a retrospective evaluation and statistical analysis of outcome in patients who underwent bulbar end-to-end anastomosis.
  
  
  METHODS
  We reviewed 153 patients with an average age of 39 years who underwent bulbar end-to-end anastomosis between 1988 and 2006. Mean followup was 68 months. Stricture etiology was unknown (62.7%), catheter (14.4%), blunt perineal trauma (11.7%), instrumentation (9.8%), radiotherapy (0.7%) and infection (0.7%). Stricture length was 1 to 2 cm (in 59.5%), 2 to 3 cm (37.9%), 3 to 4 cm (1.9%) or 4 to 5 cm (0.7%). A total of 90 patients (59%) underwent dilation, internal urethrotomy, urethroplasty or multiple procedures before being referred to our center. Clinical outcome was considered a treatment failure when any postoperative instrumentation was needed. The prevalence of postoperative sexual dysfunction was investigated using a nonvalidated questionnaire.
  
  
  RESULTS
  Of 153 cases 139 (90.8%) were successful and 14 (9.2%) were treatment failures. Treatment failure was managed with urethrotomy in 9 cases, end-to-end anastomosis in 2, buccal mucosal graft urethroplasty in 1 and 2-stage repair in 2. Of 14 cases of failure 12 had a satisfactory final outcome, 1 is still waiting for the second stage of urethroplasty and 1 underwent definitive perineostomy. There were 14 patients (23.3%) who experienced ejaculatory dysfunction, 1 (1.6%) a cold glans during erection, 7 (11.6%) a glans that was neither full nor swollen during erection and 11 (18.3%) had decreased glans sensitivity. No patients complained of penile chordee or impotence.
  
  
  CONCLUSIONS
  Bulbar end-to-end anastomosis has a success rate of 90.8%. Most patients were satisfied with the surgical outcome despite postoperative complications such as ejaculatory dysfunction, a glans that was neither full nor swollen during erection, or decreased penile sensitivity.
authors.affiliation: Center for Urethral Reconstructive Surgery, Arezzo, Italy.
authors.forename: Guido
authors.initials: G
authors.lastname: Barbagli
authors.forename: Michele
authors.initials: M
authors.lastname: De Angelis
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Romano
authors.forename: Massimo
authors.initials: M
authors.lastname: Lazzeri
mesh_terms: D000046:Academic Medical Centers; D000293:Adolescent; D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical; D016009:Chi-Square Distribution; D007172:Erectile Dysfunction / Q000209:etiology / Q000503:physiopathology; D005500:Follow-Up Studies; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000503:physiopathology; D011336:Probability; D012189:Retrospective Studies; D018570:Risk Assessment; D013997:Time Factors; D016896:Treatment Outcome; D014525:Urethral Stricture / Q000601:surgery*; D014563:Urodynamics; D013521:Urologic Surgical Procedures, Male / Q000379:methods*