Table 1.
Characteristics of studies included for analysis
| Authors, year | Study Type | No. of pati ents | Age (range), years | Months follow-up (range) | All Patients questioned about ED, pre-/postoperatively? | Questionnaire | de novo postoperative ED, n (%) | Urethroplasty type | Stricture location | Comments |
|---|---|---|---|---|---|---|---|---|---|---|
| Iselin CE, Webster GD, 1999 [15] | retrospective | 29 | 43 (10–81) | 19 (10–37) | Not stated/Not stated | No | 4 (14) | DO: 12 DO + EPA: 13 DO + PF: 4 27 used MG, 2 used BMG |
Bulbar | Moderate ED that resolved spontaneously in three patients at 6-month follow-up, one patient required PDE5i |
| Coursey JW, et al., 2001 [20] | retrospective | 152 | 45.7 (17–83) | 36 (3–149) | No/Yes | Internally validated questionnaire | 47 (30.9) | EPA: 56 BMG: 26 PF: 44 Other: 26 |
Anterior | Worse ED associated with longer stricture length, no significant difference in ED rates when compared with circumcision control group |
| Guralnick ML, Webster GD, 2001 [35] | retrospective | 29 | 44 (15–79) | 28 (3–126) | No/Yes | Non-standardized questionnaire | 1 (3.4) | DO augmented anastomosis: 20 VO augmented anastomosis: 9 7 used PF, 22 used BMG or MG |
Bulbar | - |
| Rao HS, et al., 2001 [18] | prospective | 12 | 40.5 (20–66) | 15.6 (5–25) | Not stated/Not stated | Not stated | 0 | PF | Bulbar: 5 Bulbopenile: 5 Penile: 2 |
- |
| Santucci RA, et al., 2002 [10 | retrospective | 168 | 38 (6–82) | 70 (6–291) | Not stated/Not stated | Not stated | 1 (1) | EPA | Bulbar | - |
| Dubey D, et al., 2003 [33] | retrospective | 109 | 39.5 (11–62) | 33.5 (11.4–58.7) | Not stated/Not stated | Not stated | 10 (9) | Ventral PF: 52 Dorsal PF: 23 VO + BMG or MG: 18 DO BMG or MG: 16 |
Bulbar: 56 Bulbopenile: 39 Penile: 14 |
No significant ED difference in dorsal vs ventral onlay |
| Kessler TM, et al., 2003 [26] | retrospective | 238 | 43 (28–59) | 28.9 (12–73) | Yes/Not stated | Not stated | 8 (3.4) | BMG: 30 PF: 100 EPA: 40 MG: 68 |
Membranous: 13 Membranobulbar: 12 Bulbar: 59 Bulbopenile: 67 Penile: 54 Fossa: 20 Entire length: 13 |
- |
| Hosseini J, Soltanzadeh K., 2004 [8] | retrospective | 37 | 28.5 (5–50) | 27.5 (6–50) | Not stated/No | Not stated | 1 (2.7) | VO + BMG: 18 VO + PF: 19 |
Bulbar: 13 Bulbopenile: 11 Penile: 13 |
Temporary ED, resolved after 12 months |
| Dubey D, et al., 2005, [13] | retrospective | 39 | 32.2 (11–48) | 32.5 (3–52) | Not stated/No | Not stated | 0 (0) | DO + BMG(1 stage): 25 DO + BMG(2 stage): 14 |
Bulbopenile: 30 Penile: 9 |
- |
| MacDonald MF, et al., 2005 [27] | retrospective | 54 | 46 (18–78) | 27 (3–51) | Not stated/Not stated | Not stated | 6 (11.1) | EPA: 34 VO + BMG: 20 |
Membranobulbar: 7 Bulbar: 43 Penile: 4 |
All ED was mild and responded to PDE5i |
| Raber M, et al., 2005 [16] | prospective | 30 | 42 (18–69) | 51 (20–74) | Yes/Yes | IIEF | 0 (0) | DO + MG: 17 DO + BMG:13 |
Bulbar | - |
| Morey AF, Kizer WS 2006 [32] | retrospective | 22 | 39.95 (not stated) | 26.1 (16–64) | Not stated/No | Internally validated questionnaire | 2 (9.09) | EPA | Proximal bulbar | No ED difference between end-to-end and extended anastomotic techniques |
| Anger JT, et al., 2007 [37] | prospective | 25 | 39 (26–66) | 6.2 (not stated) | Yes/Yes | IIEF | 1 (4) | EPA: 9 Augment EPA + BMG: 15 DO: 2 |
Pan-bulbar: 5 Mid-post bulbar: 13 Mid-distal bulbar: 7 |
Nonsignificant change when comparing pre- and postoperative ED; older men (>47 years) with worse preoperative EF trended towards worse postoperative EF but not significantly. |
| Barbagli G, et al., 2007 [25] | retrospective | 153 | 39 (20–50) | 68 (12–218) | No/No | Non-standardized questionnaire | 0 (0) | EPA | Bulbar | - |
| Eltahawy EA, et al., 2007 [24] | retrospective | 260 | 38.4 (14–78) | 50.2 (6–122) | Not stated/Not stated | Not stated | 6 (2.3) | EPA | Bulbar | Four with good erections with oral PDE5i, others declined therapy |
| Erickson BA, et al., 2007 [21] | retrospective | 59 | 41.7 (15–65) | 22.3 (7.5–37.1) | No/Yes | O'Leary | 13 (25) | EPA: 23 DO or VO + BMG: 22 2 stage w/BMG: 7 |
Anterior | No significant ED difference pre- vs postoperatively; postoperative EF scores improved 1 year after surgery; type of repair did not affect EF scores |
| Jain DK, et al., 2007 [30] | retrospective | 12 | 38.9 (17–58) | 14.2 (2–26) | Not stated/Not stated | Not stated | 0 | DO + BMG | Bulbar: 2 Bulbopenile: 4 Penile: 6 |
- |
| Levine LA, et al., 2007 [11] | retrospective | 53 | 45 (21–75) | 53 (15–120) | Not stated/Not stated | Not stated | 0 (0) | DO + BMG: 24 VO + BMG: 22 2 stage: 7 |
Bulbar: 35 Penile: 18 |
- |
| O'Riordan, A, et al., 2008 [29] | prospective | 52 | 39 (19–61) | 34 (12–80) | Not stated/No | Not stated | 3 (6) | DO + BMG | Bulbar | Postoperative ED resolved in two patients, not in one patient with DM |
| Singh PB, et al., 2008 [17] | retrospective | 55 | 29 (18–58) | 17.5 (not stated) | Not stated/Not stated | Not stated | 0 (0) | DO + BMG | Bulbar: 14 Penile: 11 Bulbopenile: 30 |
- |
| Ammani A, et al., 2009 [41] | prospective | 20 | 34 (19–45) | 32 (14–68) | Not stated/Yes | IIEF | 0 (0) | EPA | Bulbar | - |
| Das SK, et al., 2009 [23] | retrospective | 30 | 28 (18–58) | 9 (4–12) | Not stated/Not stated | Not stated | 0 (0) | DO + BMG | Bulbar: 6 Bulbopenile: 6 Penile: 18 |
- |
| Meeks JJ, Eriksson B,2009 [39] | not stated | 21 | 46 (18–77) | 18 (5–42) | Not stated/Not stated | Not stated | 1 (4.7) | Full thickness abdominal skin grafts | Bulbar: 11 Penile: 13 Fossa: 8 Bulbopenile: 4 |
- |
| Ortega JLL, Pena CP 2009 [34] | retrospective | 100 | 41 (18–79) | Not stated (5–125) | Not stated/Not stated | Not stated | 7 (7) | EPA: 57 DO or VO + BMG: 20 PF: 23 |
Bulbar: 78 Penile: 22 |
- |
| Rourke K 2009 [31] | prospective | 93 | Not stated | 12 (12–57) | Not stated/Not stated | Subjective symptom analysis | 5 (5) | DO + BMG augmented anastomosis | Bulbar | - |
| Seitz M, et al., 2009 [38] | not stated | 13 | 53.8 (24–76) | 12 (not stated) | Not stated/Yes | Non-standardized questionnaire | 0 | EPA: 8 DO + MG: 5 |
Bulbar: 9 Penile: 4 |
- |
| Arlen AM, et al., 2010 [12] | retrospective | 24 | 43.2 (26–71) | 10.5 (1–72) | Not stated/Not stated | No | 0 (0) | BMG | Anterior | - |
| Erickson BA, et al., 2010 [2] | prospective | 52 | 40.67 (26–56) | 7.2 (17 days to 22.8mo) | Yes/Yes | IIEF | 20 (38) | EPA: 20 Augmented EPA: 15 VO: 11 2 stage: 6 |
Bulbar: 35 Penile: 17 |
Recovery of EF in all but two patients between 92 and 398 days |
| Lumen N, et al., 2010 [40] | prospective | 10 | 36.5 (16–60) | 46.6 (15–79) | Not stated/Yes | Non-standardized questionnaire | 0 | Ventral longitudinal stricturotomy w/transverse closure 4 pts had concurrent urethroplasty at another site: PF (2 penile), BMG (2; 1 bulbar, 1 penile) | Bulbar: 6 Fossa: 4 |
- |
| Onol SY, et al., 2010 | retrospective | 16 | Not stated | 24.6 (4–96) | Not stated/Not stated | Not stated | 0 | Circular BMG | Meatal | - |
| Singh UP, et al., 2010 [22] | retrospective | 150 | 40 (18–73) | 33 (4–72) | No/Yes | O'Leary | 0 (0) | EPA: 59 DO + BMG: 55 PF: 36 |
Bulbar: 95 Bulbopenile: 47 Penile: 8 |
- |
| Andrich DE, Mundy AR 2011 [5] | retrospective | 22 | 34 (21–65) | 12 (6–21) | No/ Not stated | No | 2 (9) | Non-transecting EPA | Bulbar | Temporary ED, resolved spontaneously |
| Dogra PN, et al., 2011 [19] | prospective | 78 | 37.9 (21–71) | 15.5 (13.2–17.8) | Yes/Yes | IIEF | 15 (20) | PF: 14 DO + BMG: 29 DO + MG: 3 EPA: 32 |
Bulbar: 53 Penile: 25 |
96% recovery at 6 months, three who did not recover EF were older and had mild-to-moderate ED preoperatively. |
| Grossgold E, et al., 2011 [28] | retrospective | 28 | 46 (not stated) | 28.7 (1–114) | No/No | No | 4 (14) | DO + BMG augmented anastomosis for recurrent stricture | Bulbar | - |
| Sharma V, et al.,2011 [9] | prospective | 34 | 34.6 (18–60) | 8.4 (3–13) | Yes/Yes | O'Leary | 8 (24) | EPA: 18 Progressive perineal: 9 DO + BMG: 9 Staged: 7 |
Bulbomembranous: 2 Bulbar: 18 Penile: 7 Entire length: 7 |
- |
| Welk BK, Kodama RT 2012 [36] | retrospective | 44 | 40 (34–55) | 27.6 (14.4–45.6) | Not stated/No | Non-standardized questionnaire | 0 (0) | Non-transecting EPA: 21 DO + BMG: 23 |
Prox bulbar: 31 Distal bulbar: 10 Penile: 3 |
- |
BMG, buccal mucosa graft; DM, diabetes mellitus; DO, dorsal onlay; EPA, excision and primary anastomosis; EF, erectile function; MG, mesh graft; PDE5i, phosphodiesterase 5 inhibitor.
PF, pedicled flap; VO, ventral onlay.