title: Dorsal Onlay Urethroplasty for Membranous Urethral Strictures: Urinary and Erectile Functional Outcomes.
abstract: OBJECTIVE
  We evaluated urinary and erectile functional outcomes after dorsal onlay urethroplasty for bulbomembranous urethral strictures. Our aim was to understand the functional implications of dissection of the posterior urethra.
  
  
  METHODS
  We report on men who underwent membranous urethral stricture repair by buccal mucosal graft dorsal onlay substitution urethroplasty. Continence and erectile function were assessed preoperatively and postoperatively. Tissue routinely excised from the intercrural space during dissection of the dorsal aspect of the membranous urethra was evaluated for scar, striated muscle and nerves.
  
  
  RESULTS
  A total of 16 consecutive men with a mean age of 48.3 years (range 26 to 72) who had strictures with a mean length of 56 mm (range 15 to 170) involving the membranous urethra were included in analysis. Of the 16 men 15 were continent preoperatively and remained continent postoperatively. Three of 10 men (30%) with a preoperative SHIM (Sexual Health Inventory for Men) score of 17 to 25 had a decrease after urethroplasty. All 16 men had an improved maximum urinary flow rate with a mean improvement of 22 ml per second. I-PSS (International Prostate Symptom Score) improved from a median of 23 to 4 postoperatively with a median bother score improvement of 5 to 0. Histopathological assessment identified striated muscle and nerves in 6 (46%) and 9 (69%) of 13 specimens. Overall nerves and muscle comprised an average of less than 15% of the specimen.
  
  
  CONCLUSIONS
  The dorsal onlay technique with a buccal mucosal graft for membranous urethral stricture repair does not compromise continence or erectile function in most patients. Dissection at the level of the membranous urethra should be limited because striated muscle and cavernous nerves are present.
authors.affiliation: State University of New York Upstate Medical University, Department of Urology, Syracuse, New York; State University of New York Upstate Medical University, Department of Pathology (TC, SL), Syracuse, New York.
authors.forename: Stephen
authors.initials: S
authors.lastname: Blakely
authors.affiliation: State University of New York Upstate Medical University, Department of Urology, Syracuse, New York; State University of New York Upstate Medical University, Department of Pathology (TC, SL), Syracuse, New York.
authors.forename: Tiffany
authors.initials: T
authors.lastname: Caza
authors.affiliation: State University of New York Upstate Medical University, Department of Urology, Syracuse, New York; State University of New York Upstate Medical University, Department of Pathology (TC, SL), Syracuse, New York.
authors.forename: Steve
authors.initials: S
authors.lastname: Landas
authors.affiliation: State University of New York Upstate Medical University, Department of Urology, Syracuse, New York; State University of New York Upstate Medical University, Department of Pathology (TC, SL), Syracuse, New York. Electronic address: nikolavd@upstate.edu.
authors.forename: Dmitriy
authors.initials: D
authors.lastname: Nikolavsky
mesh_terms: D000328:Adult; D000368:Aged; D003558:Cystoscopy; D006801:Humans; D008297:Male; D008875:Middle Aged; D009061:Mouth Mucosa / Q000637:transplantation*; D010410:Penile Erection / Q000502:physiology*; D019651:Plastic Surgery Procedures / Q000379:methods*; D020127:Recovery of Function; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014521:Urethra / Q000601:surgery*; D014525:Urethral Stricture / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D014563:Urodynamics; D014567:Urography; D013521:Urologic Surgical Procedures, Male / Q000379:methods*
keywords: mouth mucosa; penile erection; transplants; urethral stricture; urinary incontinence