Ventral versus dorsal onlay buccal mucosal graft urethroplasty for non-traumatic proximal bulbar urethral strictures in sexually active men: erectile and urinary functions

Purpose To compare the erectile and urinary functions of ventral and dorsal onlay buccal mucosal graft (BMG) urethroplasty in the management of proximal bulbar urethral strictures (PBUS) in sexually active men. Patients and methods We retrospectively included patients with primary non-traumatic PBUS who were treated with (BMG) urethroplasty at our department between March 2019 and March 2023 either ventral or dorsal approaches. Patients were assessed at 3- and 12-months postoperatively for urinary and erectile functions. Results133 patients were identified and underwent either ventral repair (n = 60, group I) or dorsal repair (n = 73, group II). There was no significant difference in baseline urinary and sexual function between both groups (p > 0.05). Overall, the success rate was 91.7% in Group I and 90.4% in Group II (p = 0.801). Transient ED (at 3 months) was detected in 5% and 25% (p = 0.002), while permeant ED (at 12 months) was 1.7% and 13.7% (p = 0.012) in group I and group II, respectively. Group I had significantly higher mean IIEF scores; 28.2 and 28.4 at 3 months (p < 0.001) and 12 months (p < 0.001); compared to Group II; 22.1 and 24.4, respectively. Conclusion The ventral approach had better erectile functional outcomes compared to the dorsal approach in the management of non-traumatic PBUS in sexually active men. This might be related to less urethral mobilization and no dissection of the intercrural space during ventral onlay graft urethroplasty.