Sexual Outcomes After Buccal Mucosal Graft Urethroplasty: Benefits and Complications

Sexual Outcomes After Buccal Mucosal Graft Urethroplasty: Benefits and Complications | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Sexual Outcomes After Buccal Mucosal Graft Urethroplasty: Benefits and Complications Hosny Fathalla, Atef Galal, Wael Gamal, Elnisr Rashed, Ahmed Riyad This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8492182/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Objective To evaluate the sexual outcomes, including both benefits and complications, following buccal mucosal graft (BMG) urethroplasty in male patients. Methods A retrospective study was conducted on 160 patients came in the duration between February 2020 to December 2023 who underwent BMG urethroplasty for anterior urethral stricture longer than 3 cm. All patients were followed for a minimum of 2 years. Operative details, sexual function outcomes, and postoperative complications were recorded. Results The mean age was 39 ± 10.5 years old. Body mass index 27.3 ± 4.2 kg/m². Diabetes Mellitus in 8 cases, Hypertension in 18 cases. Aetiology of stricture was iatrogenic trauma in 60% of cases, 20% inflammatory ,15% lichen sclerosus and 5% idiopathic stricture. Operative time was 180 ± 25.6 minutes. Postoperative evaluation revealed significant improvement in international index of erectile function (IIEF-5) scores, indicating enhancement of erectile function in most patients. However, sexual complications were observed in a subset of cases: eight patients (5%) developed moderate erectile dysfunction, while five (3%) exhibited ventral penile curvature. Among those with curvature, three experienced spontaneous resolution, whereas two required surgical correction. Conclusion Buccal mucosal urethroplasty generally leads to improved erectile function and favorable sexual outcomes. Nevertheless, moderate erectile dysfunction and ventral curvature may occur as infrequent complications that require appropriate evaluation and management. buccal mucosal graft urethroplasty erectile function sexual outcomes complications Figures Figure 1 Introduction Urethral stricture disease is a frequent cause of lower urinary tract symptoms in men and often requires reconstructive surgery when minimally invasive treatments fail or recurrence occurs. Buccal mucosa graft (BMG) substitution has become the preferred graft for many anterior urethral reconstructions because buccal mucosa is hairless, readily available, thick-epithelialized and reliably revascularizes at the recipient site, resulting in high long-term patency in contemporary series. 1 While achieving durable urethral patency remains the primary objective of urethroplasty, patient-centred outcomes — particularly sexual function — are now recognized as essential measures of success. Reported sexual domains potentially affected by urethral reconstruction include erectile function, ejaculatory function, penile form (length, curvature), genital sensation and partner satisfaction. Most large series and recent narrative reviews report that persistent long-term erectile dysfunction after BMG is uncommon, and many postoperative sexual complaints are transient, but the exact incidence and time course vary between studies and techniques. 1,2 Technique-specific factors appear to influence sexual morbidity: graft (non-transecting) augmentation procedures tend to be associated with lower rates of penile deformity and long-term sexual complaints than transecting excision-and-primary-anastomosis repairs, although heterogeneity in outcome measurement and limited randomized data limit firm conclusions .2 Donor-site morbidity after buccal harvest — including early oral pain, numbness, tightness, and rarely persistent difficulty with mastication or mouth opening — also contributes to overall postoperative bother and should be included in counselling and outcomes assessment. 3,4 Measurement heterogeneity (different questionnaires, different follow-up intervals and varying definitions of dysfunction) remains a major obstacle to pooling outcomes across series. 5 For this reason, contemporary analyses that emphasise validated patient-reported outcome measures and report both genital and oral endpoints provide the most clinically useful information for preoperative counselling. The present study aims to characterise sexual outcomes after BMG urethroplasty across erectile, ejaculatory, penile shape and donor-site oral outcomes and draw practical recommendations for patient counselling and postoperative follow-up. Study design This retrospective study was carried out in the Urology Department of Sohag University Hospital, Upper Egypt, over a four-year period from February 2020 to December 2023. The study received approval from the Ethical Research Committee of the Faculty of Medicine, Sohag University. Written informed consent was obtained from all participating patients prior to inclusion. Data Collection The study included patients scheduled for buccal mucosal graft urethroplasty due to non-obliterative anterior urethral strictures measuring longer than3 cm. The final decision to perform buccal graft urethroplasty was confirmed intraoperatively. Patients were excluded if they had oral pathologies, were deemed unfit for surgery based on anesthetic assessment, bleeding disorders, or were children. Those with coexisting bladder or urethral lesions such as stones or masses were also excluded. During the study period, 160 patients fulfilled the inclusion criteria and were enrolled. Surgical technique: One side fixation of the buccal mucosa as a substitution urethroplasty (Kulkarni technique) was the approach for all cases. Starting with spinal anaesthesia and lithotomy position to prepare the urethral field. Proper sterilization of the skin of the abdomen, scrotum and perineum down to the thigh. Through a midline perineal incision, the urethra is exposed and dissected from one side but remained attached to the corpora cavernosa in midline. Methylene blue injected through the meatus and the urethra was opened along the dorsal surface. The buccal mucosal graft was harvested from the cheek and if needed from lower lip, after hydrodissection by injection of solution of Adrenaline in saline (1 ampoule dissolved in 200 ml saline) and harvesting the mucosa about 2.5 cm in width and as long as possible. The bed left open after ensuring of good haemostasis. The oral mucosa graft was sutured and fixed to the corpus cavernosum ventral surface after defatting and meshing of the graft. A Foley 18 Fr. Silicone catheter was inserted. The entire length urethral edge is connected with the side of fixed buccal mucosa, to encircle the catheter as a tube. Then the graft was totally covered by the spongiosum and muscles. After this step, we insert a suction drain and close the other layers up to skin by interrupted absorbable sutures. Catheter was left for one month. Suprapubic tube and suction drain are fixed to all patients. Definition of Success of the operation was a Qmax ≥ 14 ml / sec. and patent urethrogram with improved international prostate symptom score (IPSS). Definition of Failure was presence of obstructive lower urinary tract symptoms (LUTS), Qmax < 14 ml / sec., re-stricture in postoperative urethrogram and any postoperative urethral intervention, like dilatation or urethroplasty. These measurements were done 24 months postoperatively after serial follow up periods in between the time of operation and 24 months later on. Statistical analysis: The results were analysed using SPSS version 26 application. The significance was determined at a p value 3 cm underwent oral mucosal substitution urethroplasty. All cases underwent substitution urethroplasty using the dorsolateral approach. Aetiology of stricture was iatrogenic trauma in 96 cases in the form of (traumatic catheterization 56 cases and transurethral (TUR) procedures in 40 cases), inflammatory in 32 cases, lichen sclerosus in 24 cases and 8 cases of idiopathic etiology. Intraoperative stricture length was 5 ± 1.8 cm, operative time was 180 ± 25.6 minutes. The post operative Qmax was 23.8 ± 8.3 ml/sec with postvoid residual urine of 58.8 ± 22.4 ml with P value of 0.02. Postoperative hospital stay was 4.5 ± 1.2 days. Success rates : Success criteria were found in 131 cases (81.8%), having good urine flow during the time of the follow up which was during the first postoperative 24 months. They have patent urethrogram and improved IPSS score. As regard the complications, early complications occurred before catheter removal were 7 cases of Epididimo-orchitis managed with medications ,4 cases of perineal abscess needed evacuation, late complications were noticed during the follow up period after catheter removal were 19 cases of short bulbar urethral strictures managed by VIU, 3 cases of short penile stricture needed Teflon dilatation and 7 cases of long urethral stricture recurrence which were managed by insertion of suprapubic tube in emergency room, and later on they underwent buccal graft and skin graft urethroplasty. Sexual outcomes: Benefits Of the 160 patients who underwent anterior urethroplasty using BMG substitution, 147 patients experience improvement of their sexual function, the mean IIEF-5 score showed a significant improvement from 15.8 ± 4.2 before surgery to 21 ± 3.9 after surgery, indicating enhanced erectile function following the procedure (P value < 0.05). Complications During the 2-year follow-up period ,8 patients developed erectile dysfunction and 5 patients presented with ventral penile curvature. Among those with ED ,5 patients showed improvement with Phosphodiesterase 5 (PDE5) inhibitors, 2 were lost to follow-up, and 1 patient required implantation of a malleable penile prothesis. Of the patients with curvature, 3 improved spontaneously ,1 underwent dorsal plication and 1 was lost to follow-up. Table 1 Preoperative data of the study population. Variable Result (n = 160) P-value Age(year) 39 ± 10.5 0.5 BMI 28.4 ± 4.2 0.9 Comorbidities : DM 8(5%) 0.49 HTN 18(11.25%) 0.34 IIEF-5 preoperative 15.8 ± 4.2 0.12 IPSS score preoperative 26.84 ± 2.01 0.25 Preoperative Qmax(ml/sec) 6.76 ± 1.78 0.87 Preoperative PVR (ml) 275.0 ± 55.7 0.1 Table 2 post-operative measurements after 24 months. Data measured 24 months postoperatively Dorsolateral Approach Pvalue Postoperative Qmax(ml/sec) 23.8 ± 8.3 ml/sec 0.01 Postoperative PVR (ml) 58.8 ± 22.4 ml 0.001 IIEF-5 score. 21 ± 3.9 0.05* IPSS score. 5.54 ± 1.62 < 0.001 Discussion Anterior urethral stricture disease is a common urological problem that significantly affects lower urinary tract function and patients’ quality of life. It frequently results from iatrogenic injury, infection, lichen sclerosus, or trauma, leading to obstructive voiding symptoms and recurrent urinary retention [ 6 , 7 ]. Substitution urethroplasty using buccal mucosal graft (BMG) has become the gold standard for managing long or complex anterior strictures, offering durable success rates and excellent tissue compatibility [ 8 , 9 ]. Beyond anatomical patency, sexual function—including erectile, ejaculatory, and orgasmic components—has emerged as a critical determinant of postoperative satisfaction [ 10 , 11 ]. However, reports on sexual outcomes after urethroplasty vary widely, reflecting differences in surgical technique, stricture characteristics, and assessment tools. Some studies suggest that erectile dysfunction (ED) after urethroplasty is usually transient and more common following excision and primary anastomosis (EPA) than after substitution urethroplasty [ 12 – 14 ]. Because of the intimate relationship between the bulbar urethra, cavernous nerves, and penile vasculature, surgical dissection may transiently affect sexual performance. Thus, evaluating the benefits and complications of BMG urethroplasty from a sexual perspective is essential for comprehensive counselling and outcome assessment. Our findings demonstrate that most patients undergoing anterior urethroplasty with buccal mucosal substitution maintain or improve erectile and ejaculatory function during follow-up. This is consistent with recent meta-analyses showing that BMG urethroplasty yields favourable sexual outcomes compared with EPA techniques, particularly in terms of preserving erectile function and penile morphology [ 12 , 15 ]. The mechanism of postoperative erectile changes is multifactorial. Temporary neural or vascular disturbance due to urethral mobilisation or intraoperative stretching may cause transient ED, but the preservation of the corpus spongiosum and cavernous nerve branches during the dorsolateral approach limits permanent damage [ 16 , 17 ]. Most studies report recovery of erectile function within 6–12 months after surgery [ 13 , 18 ]. Ejaculatory and orgasmic function also tend to improve after successful urethroplasty due to restoration of unobstructed urinary flow and relief of chronic pelvic strain [ 19 ]. However, some patients may experience decreased glans sensitivity, penile curvature, or painful ejaculation, although these complications are uncommon [ 20 , 21 ]. In our cohort, the overall incidence of de novo ED and penile curvature was low, and most affected patients responded to phosphodiesterase-5 inhibitors. Previous prospective analyses using validated questionnaires such as the International Index of Erectile Function (IIEF) have confirmed statistically significant postoperative improvement in mean IIEF scores following BMG urethroplasty [ 12 , 15 , 22 ]. These results highlight that the perceived risk of long-term sexual dysfunction is often overestimated and that BMG substitution provides both functional and sexual rehabilitation in most patients. Other series report variable rates of sexual sequelae after anterior urethroplasty. Erickson et al prospectively found postoperative erectile dysfunction in 38% (52 patients) ، but 18/20 recovered at a mean of 190 days [ 23 ]. D’hulst et al. (n = 97) observed a statistically significant early drop in median IIEF-5 scores that resolved by a median 17-month visit [ 24 ]. Larger retrospective series (n = 245) showed transient ED more commonly after transecting techniques but permanent de-novo ED remained uncommon (~ 3%) [ 25 ]. Meta-analysis of 36 studies (≈ 2,323 patients) found that de-novo permanent ED is rare (pooled ≈ 1%) while most postoperative declines are transient and resolve within 6–12 months [ 26 ]. These data support our findings that most sexual changes after buccal mucosal graft urethroplasty are transient, and emphasize the need for baseline patient reported outcome measures (PROMs) and medium-term follow-up when reporting sexual outcomes [ 27 ]. Limitations in the current literature were its retrospective single centre nature, lack of a control group, and possible selection bias. Future multicentric prospective trials are needed to refine patient counselling and identify predictors of postoperative sexual dysfunction. Conclusions Buccal mucosal urethroplasty remains a reliable and effective technique for the management of anterior urethral stricture, offering high success rates and satisfactory postoperative functional outcomes. In addition to restoring urethral patency, this procedure is associated with favourable sexual outcomes in most patients, with minimal risk of permanent erectile dysfunction or penile deformity. Although a small proportion of patients may experience transient sexual complications such as erectile changes or penile curvature, these effects are generally mild and tend to improve over time. Careful surgical technique and patient counselling are essential to optimize results and address postoperative concerns. Long-term, multicenter prospective studies with standardized sexual function assessment tools are recommended to further clarify the impact of buccal mucosal urethroplasty on male sexual health. Declarations The messages from this study are: High efficacy: Buccal mucosal urethroplasty provides excellent stricture resolution and sustained urethral patency. Sexual outcomes: Most patients preserve or regain satisfactory erectile and ejaculatory function after surgery. Complications: Mild, temporary erectile dysfunction or penile curvature can occur but are uncommon. Clinical focus: Detailed preoperative assessment and patient counselling enhance expectations and satisfaction. Future direction: Larger multicenter studies using validated sexual function tools are recommended for stronger evidence. Conflicts of Interest : The authors have no conflicts of interest to declare. Ethical Statement : Ethical committee of Sohag Faculty of medicine approved the study and informed written consent taken from all participants. Author Contribution All authors were operators and share equally in everything References Foreman J, Peterson A, Krughoff K. Buccal mucosa for use in urethral reconstruction: evolution of use over the last 30 years. Frontiers in Urology. 2023 May 2;3. doi:10.3389/fruro.2023.1138707. Zhao X, Guo Q, Zhang X, Xing Q, Ren S, Song Y, et al. The urinary and sexual outcomes of buccal mucosal graft urethroplasty versus end-to-end anastomosis: a systematic review with meta-analysis. Sex Med. 2024 Aug;12(4): qfae064. doi:10.1093/sexmed/qfae064. Hwang EC, de Fazio A, Hamilton K, Bakker C, Pariser JJ, Dahm P. A systematic review of randomized controlled trials comparing buccal mucosal graft harvest site non-closure versus closure in patients undergoing urethral reconstruction. World J Mens Health. 2022; [article]. doi:10.5534/wjmh.200175. 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Erectile function after anterior urethroplasty. J Urol. 2001; 166:2273–6. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. 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1","display":"","copyAsset":false,"role":"figure","size":88569,"visible":true,"origin":"","legend":"\u003cp\u003eShowing postoperative urethrogram in one of the patients. The same patient came with a picture of penile curvature during erection.\u003c/p\u003e","description":"","filename":"1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-8492182/v1/d48eca2f82249f4c711fbd54.jpg"},{"id":101752487,"identity":"48dc8b29-70ea-42be-b5b5-373d9c446036","added_by":"auto","created_at":"2026-02-03 10:27:46","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":696476,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8492182/v1/edf814ac-46fd-4f36-aaf3-1d9e305a4660.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Sexual Outcomes After Buccal Mucosal Graft Urethroplasty: Benefits and Complications","fulltext":[{"header":"Introduction","content":"\u003cp\u003eUrethral stricture disease is a frequent cause of lower urinary tract symptoms in men and often requires reconstructive surgery when minimally invasive treatments fail or recurrence occurs. Buccal mucosa graft (BMG) substitution has become the preferred graft for many anterior urethral reconstructions because buccal mucosa is hairless, readily available, thick-epithelialized and reliably revascularizes at the recipient site, resulting in high long-term patency in contemporary series.\u003cb\u003e1\u003c/b\u003e\u003c/p\u003e \u003cp\u003eWhile achieving durable urethral patency remains the primary objective of urethroplasty, patient-centred outcomes — particularly sexual function — are now recognized as essential measures of success. Reported sexual domains potentially affected by urethral reconstruction include erectile function, ejaculatory function, penile form (length, curvature), genital sensation and partner satisfaction. Most large series and recent narrative reviews report that persistent long-term erectile dysfunction after BMG is uncommon, and many postoperative sexual complaints are transient, but the exact incidence and time course vary between studies and techniques.\u003cb\u003e1,2\u003c/b\u003e\u003c/p\u003e \u003cp\u003eTechnique-specific factors appear to influence sexual morbidity: graft (non-transecting) augmentation procedures tend to be associated with lower rates of penile deformity and long-term sexual complaints than transecting excision-and-primary-anastomosis repairs, although heterogeneity in outcome measurement and limited randomized data limit firm conclusions\u003cb\u003e.2\u003c/b\u003e Donor-site morbidity after buccal harvest — including early oral pain, numbness, tightness, and rarely persistent difficulty with mastication or mouth opening — also contributes to overall postoperative bother and should be included in counselling and outcomes assessment.\u003cb\u003e3,4\u003c/b\u003e\u003c/p\u003e \u003cp\u003eMeasurement heterogeneity (different questionnaires, different follow-up intervals and varying definitions of dysfunction) remains a major obstacle to pooling outcomes across series.\u003cb\u003e5\u003c/b\u003e For this reason, contemporary analyses that emphasise validated patient-reported outcome measures and report both genital and oral endpoints provide the most clinically useful information for preoperative counselling. The present study aims to characterise sexual outcomes after BMG urethroplasty across erectile, ejaculatory, penile shape and donor-site oral outcomes and draw practical recommendations for patient counselling and postoperative follow-up.\u003c/p\u003e\n\n \n\n "},{"header":"Study design","content":"\u003cp\u003eThis retrospective study was carried out in the Urology Department of Sohag University Hospital, Upper Egypt, over a four-year period from February 2020 to December 2023. The study received approval from the Ethical Research Committee of the Faculty of Medicine, Sohag University. Written informed consent was obtained from all participating patients prior to inclusion.\u003c/p\u003e\u003ch2\u003eData Collection\u003c/h2\u003e\u003cp\u003eThe study included patients scheduled for buccal mucosal graft urethroplasty due to non-obliterative anterior urethral strictures measuring longer than3 cm. The final decision to perform buccal graft urethroplasty was confirmed intraoperatively.\u003c/p\u003e\u003cp\u003ePatients were excluded if they had oral pathologies, were deemed unfit for surgery based on anesthetic assessment, bleeding disorders, or were children. Those with coexisting bladder or urethral lesions such as stones or masses were also excluded. During the study period, 160 patients fulfilled the inclusion criteria and were enrolled.\u003c/p\u003e\u003ch3\u003eSurgical technique:\u003c/h3\u003e\u003cp\u003eOne side fixation of the buccal mucosa as a substitution urethroplasty (Kulkarni technique) was the approach for all cases. Starting with spinal anaesthesia and lithotomy position to prepare the urethral field. Proper sterilization of the skin of the abdomen, scrotum and perineum down to the thigh. Through a midline perineal incision, the urethra is exposed and dissected from one side but remained attached to the corpora cavernosa in midline. Methylene blue injected through the meatus and the urethra was opened along the dorsal surface. The buccal mucosal graft was harvested from the cheek and if needed from lower lip, after hydrodissection by injection of solution of Adrenaline in saline (1 ampoule dissolved in 200 ml saline) and harvesting the mucosa about 2.5 cm in width and as long as possible. The bed left open after ensuring of good haemostasis. The oral mucosa graft was sutured and fixed to the corpus cavernosum ventral surface after defatting and meshing of the graft. A Foley 18 Fr. Silicone catheter was inserted. The entire length urethral edge is connected with the side of fixed buccal mucosa, to encircle the catheter as a tube. Then the graft was totally covered by the spongiosum and muscles. After this step, we insert a suction drain and close the other layers up to skin by interrupted absorbable sutures. Catheter was left for one month. Suprapubic tube and suction drain are fixed to all patients. Definition of Success of the operation was a Qmax ≥ 14 ml / sec. and patent urethrogram with improved international prostate symptom score (IPSS). Definition of Failure was presence of obstructive lower urinary tract symptoms (LUTS), Qmax \u0026lt; 14 ml / sec., re-stricture in postoperative urethrogram and any postoperative urethral intervention, like dilatation or urethroplasty. These measurements were done 24 months postoperatively after serial follow up periods in between the time of operation and 24 months later on.\u003c/p\u003e\u003ch2\u003eStatistical analysis:\u003c/h2\u003e\u003cp\u003eThe results were analysed using SPSS version 26 application. The significance was determined at a \u003cem\u003ep\u003c/em\u003e value \u0026lt; 0.05.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eThe study included 160 patients with long anterior urethral stricture\u0026thinsp;\u0026gt;\u0026thinsp;3 cm underwent oral mucosal substitution urethroplasty. All cases underwent substitution urethroplasty using the dorsolateral approach. Aetiology of stricture was iatrogenic trauma in 96 cases in the form of (traumatic catheterization 56 cases and transurethral (TUR) procedures in 40 cases), inflammatory in 32 cases, lichen sclerosus in 24 cases and 8 cases of idiopathic etiology. Intraoperative stricture length was 5\u0026thinsp;\u0026plusmn;\u0026thinsp;1.8 cm, operative time was 180\u0026thinsp;\u0026plusmn;\u0026thinsp;25.6 minutes. The post operative Qmax was 23.8\u0026thinsp;\u0026plusmn;\u0026thinsp;8.3 ml/sec with postvoid residual urine of 58.8\u0026thinsp;\u0026plusmn;\u0026thinsp;22.4 ml with P value of 0.02. Postoperative hospital stay was 4.5\u0026thinsp;\u0026plusmn;\u0026thinsp;1.2 days. \u003cb\u003eSuccess rates\u003c/b\u003e: Success criteria were found in 131 cases (81.8%), having good urine flow during the time of the follow up which was during the first postoperative 24 months. They have patent urethrogram and improved IPSS score. As regard the complications, early complications occurred before catheter removal were 7 cases of Epididimo-orchitis managed with medications ,4 cases of perineal abscess needed evacuation, late complications were noticed during the follow up period after catheter removal were 19 cases of short bulbar urethral strictures managed by VIU, 3 cases of short penile stricture needed Teflon dilatation and 7 cases of long urethral stricture recurrence which were managed by insertion of suprapubic tube in emergency room, and later on they underwent buccal graft and skin graft urethroplasty.\u003c/p\u003e\n\u003ch3\u003eSexual outcomes:\u003c/h3\u003e\n\u003cp\u003e \u003cstrong\u003eBenefits\u003c/strong\u003e \u003cp\u003eOf the 160 patients who underwent anterior urethroplasty using BMG substitution, 147 patients experience improvement of their sexual function, the mean IIEF-5 score showed a significant improvement from 15.8\u0026thinsp;\u0026plusmn;\u0026thinsp;4.2 before surgery to 21\u0026thinsp;\u0026plusmn;\u0026thinsp;3.9 after surgery, indicating enhanced erectile function following the procedure \u003cb\u003e(P value\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/b\u003e\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eComplications\u003c/strong\u003e \u003cp\u003eDuring the 2-year follow-up period ,8 patients developed erectile dysfunction and 5 patients presented with ventral penile curvature. Among those with ED ,5 patients showed improvement with Phosphodiesterase 5 (PDE5) inhibitors, 2 were lost to follow-up, and 1 patient required implantation of a malleable penile prothesis. Of the patients with curvature, 3 improved spontaneously ,1 underwent dorsal plication and 1 was lost to follow-up.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePreoperative data of the study population.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eResult (n\u0026thinsp;=\u0026thinsp;160)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge(year)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e39\u0026thinsp;\u0026plusmn;\u0026thinsp;10.5\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.5\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e28.4\u0026thinsp;\u0026plusmn;\u0026thinsp;4.2\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.9\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eComorbidities\u003c/b\u003e:\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDM\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8(5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.49\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHTN\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18(11.25%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.34\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eIIEF-5 preoperative\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15.8\u0026thinsp;\u0026plusmn;\u0026thinsp;4.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.12\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eIPSS score preoperative\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e26.84\u0026thinsp;\u0026plusmn;\u0026thinsp;2.01\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.25\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePreoperative Qmax(ml/sec)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6.76\u0026thinsp;\u0026plusmn;\u0026thinsp;1.78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.87\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePreoperative PVR (ml)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e275.0\u0026thinsp;\u0026plusmn;\u0026thinsp;55.7\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003epost-operative measurements after 24 months.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eData measured 24 months postoperatively\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDorsolateral\u003c/p\u003e \u003cp\u003eApproach\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePvalue\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePostoperative Qmax(ml/sec)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23.8\u0026thinsp;\u0026plusmn;\u0026thinsp;8.3 ml/sec\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePostoperative PVR (ml)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e58.8\u0026thinsp;\u0026plusmn;\u0026thinsp;22.4 ml\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eIIEF-5 score.\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21\u0026thinsp;\u0026plusmn;\u0026thinsp;3.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.05*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eIPSS score.\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.54\u0026thinsp;\u0026plusmn;\u0026thinsp;1.62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eAnterior urethral stricture disease is a common urological problem that significantly affects lower urinary tract function and patients\u0026rsquo; quality of life. It frequently results from iatrogenic injury, infection, lichen sclerosus, or trauma, leading to obstructive voiding symptoms and recurrent urinary retention [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Substitution urethroplasty using buccal mucosal graft (BMG) has become the gold standard for managing long or complex anterior strictures, offering durable success rates and excellent tissue compatibility [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Beyond anatomical patency, sexual function\u0026mdash;including erectile, ejaculatory, and orgasmic components\u0026mdash;has emerged as a critical determinant of postoperative satisfaction [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. However, reports on sexual outcomes after urethroplasty vary widely, reflecting differences in surgical technique, stricture characteristics, and assessment tools. Some studies suggest that erectile dysfunction (ED) after urethroplasty is usually transient and more common following excision and primary anastomosis (EPA) than after substitution urethroplasty [\u003cspan additionalcitationids=\"CR13\" citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Because of the intimate relationship between the bulbar urethra, cavernous nerves, and penile vasculature, surgical dissection may transiently affect sexual performance. Thus, evaluating the benefits and complications of BMG urethroplasty from a sexual perspective is essential for comprehensive counselling and outcome assessment.\u003c/p\u003e \u003cp\u003eOur findings demonstrate that most patients undergoing anterior urethroplasty with buccal mucosal substitution maintain or improve erectile and ejaculatory function during follow-up. This is consistent with recent meta-analyses showing that BMG urethroplasty yields favourable sexual outcomes compared with EPA techniques, particularly in terms of preserving erectile function and penile morphology [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. The mechanism of postoperative erectile changes is multifactorial. Temporary neural or vascular disturbance due to urethral mobilisation or intraoperative stretching may cause transient ED, but the preservation of the corpus spongiosum and cavernous nerve branches during the dorsolateral approach limits permanent damage [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Most studies report recovery of erectile function within 6\u0026ndash;12 months after surgery [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Ejaculatory and orgasmic function also tend to improve after successful urethroplasty due to restoration of unobstructed urinary flow and relief of chronic pelvic strain [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. However, some patients may experience decreased glans sensitivity, penile curvature, or painful ejaculation, although these complications are uncommon [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. In our cohort, the overall incidence of de novo ED and penile curvature was low, and most affected patients responded to phosphodiesterase-5 inhibitors. Previous prospective analyses using validated questionnaires such as the International Index of Erectile Function (IIEF) have confirmed statistically significant postoperative improvement in mean IIEF scores following BMG urethroplasty [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. These results highlight that the perceived risk of long-term sexual dysfunction is often overestimated and that BMG substitution provides both functional and sexual rehabilitation in most patients.\u003c/p\u003e \u003cp\u003eOther series report variable rates of sexual sequelae after anterior urethroplasty. Erickson et al prospectively found postoperative erectile dysfunction in 38% (52 patients) ، but 18/20 recovered at a mean of 190 days [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. D\u0026rsquo;hulst et al. (n\u0026thinsp;=\u0026thinsp;97) observed a statistically significant early drop in median IIEF-5 scores that resolved by a median 17-month visit [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Larger retrospective series (n\u0026thinsp;=\u0026thinsp;245) showed transient ED more commonly after transecting techniques but permanent de-novo ED remained uncommon (~\u0026thinsp;3%) [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Meta-analysis of 36 studies (\u0026asymp;\u0026thinsp;2,323 patients) found that de-novo permanent ED is rare (pooled\u0026thinsp;\u0026asymp;\u0026thinsp;1%) while most postoperative declines are transient and resolve within 6\u0026ndash;12 months [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. These data support our findings that most sexual changes after buccal mucosal graft urethroplasty are transient, and emphasize the need for baseline patient reported outcome measures (PROMs) and medium-term follow-up when reporting sexual outcomes [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eLimitations in the current literature were its retrospective single centre nature, lack of a control group, and possible selection bias. Future multicentric prospective trials are needed to refine patient counselling and identify predictors of postoperative sexual dysfunction.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eBuccal mucosal urethroplasty remains a reliable and effective technique for the management of anterior urethral stricture, offering high success rates and satisfactory postoperative functional outcomes. In addition to restoring urethral patency, this procedure is associated with favourable sexual outcomes in most patients, with minimal risk of permanent erectile dysfunction or penile deformity. Although a small proportion of patients may experience transient sexual complications such as erectile changes or penile curvature, these effects are generally mild and tend to improve over time. Careful surgical technique and patient counselling are essential to optimize results and address postoperative concerns. Long-term, multicenter prospective studies with standardized sexual function assessment tools are recommended to further clarify the impact of buccal mucosal urethroplasty on male sexual health.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eThe messages from this study are:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHigh efficacy:\u003c/strong\u003e Buccal mucosal urethroplasty provides excellent stricture resolution and sustained urethral patency.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSexual outcomes:\u003c/strong\u003e Most patients preserve or regain satisfactory erectile and ejaculatory function after surgery.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eComplications:\u003c/strong\u003e Mild, temporary erectile dysfunction or penile curvature can occur but are uncommon.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical focus:\u003c/strong\u003e Detailed preoperative assessment and patient counselling enhance expectations and satisfaction.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFuture direction:\u003c/strong\u003e Larger multicenter studies using validated sexual function tools are recommended for stronger evidence.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflicts of Interest\u003c/strong\u003e\u003cem\u003e:\u0026nbsp;\u003c/em\u003eThe authors have no conflicts of interest to declare.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical Statement\u003c/strong\u003e\u003cem\u003e:\u0026nbsp;\u003c/em\u003eEthical committee of Sohag Faculty of medicine approved the study and informed written consent taken from all participants.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eAll authors were operators and share equally in everything\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eForeman J, Peterson A, Krughoff K. Buccal mucosa for use in urethral reconstruction: evolution of use over the last 30 years. Frontiers in Urology. 2023 May 2;3. doi:10.3389/fruro.2023.1138707.\u003c/li\u003e\n\u003cli\u003eZhao X, Guo Q, Zhang X, Xing Q, Ren S, Song Y, et al. The urinary and sexual outcomes of buccal mucosal graft urethroplasty versus end-to-end anastomosis: a systematic review with meta-analysis. Sex Med. 2024 Aug;12(4): qfae064. doi:10.1093/sexmed/qfae064.\u003c/li\u003e\n\u003cli\u003eHwang EC, de Fazio A, Hamilton K, Bakker C, Pariser JJ, Dahm P. A systematic review of randomized controlled trials comparing buccal mucosal graft harvest site non-closure versus closure in patients undergoing urethral reconstruction. World J Mens Health. 2022; [article]. doi:10.5534/wjmh.200175.\u003c/li\u003e\n\u003cli\u003eJang TL, Erickson B, Medendorp A, Gonzalez CM. Comparison of donor site intraoral morbidity after mucosal graft harvesting for urethral reconstruction. Urology. 2005 Oct;66(4):716\u0026ndash;20. doi: 10.1016/j.urology.2005.04.045.\u003c/li\u003e\n\u003cli\u003eGupta R, Wang H, Gupta S, et al. Current potential outcomes of buccal mucosal graft anterior urethroplasty for male urethral stricture: a single-centre study in Nepal. Cureus. 2024 Sep 28;16(9):e70379. doi:10.7759/cureus.70379.\u003c/li\u003e\n\u003cli\u003eTritschler S, Roosen A, F\u0026uuml;llhase C, Stief CG, R\u0026uuml;bben H. Urethral stricture: etiology, investigation and treatments. Dtsch Arztebl Int. 2013;110(13):220-6.\u003c/li\u003e\n\u003cli\u003ePalminteri E, Berdondini E, De Nunzio C, et al. Contemporary urethral stricture characteristics in the developed world. Urology. 2013;81(1):191-6.\u003c/li\u003e\n\u003cli\u003eBarbagli G, Lazzeri M. Buccal mucosal graft urethroplasty: review of the literature. Curr Opin Urol. 2015;25(4):316-22.\u003c/li\u003e\n\u003cli\u003eBhargava S, Chapple CR. Buccal mucosal graft urethroplasty: is it the new gold standard? BJU Int. 2004;93(9):1191-3.\u003c/li\u003e\n\u003cli\u003eErickson BA, Wysock JS, McVary KT, Gonzalez CM. Erectile function, sexual drive, and ejaculatory function after reconstructive surgery for anterior urethral stricture disease. BJU Int. 2007;99(3):607-11.\u003c/li\u003e\n\u003cli\u003eCoursey JW, Morey AF, McAninch JW, et al. Erectile function after anterior urethroplasty. J Urol. 2001;166(6):2273-6.\u003c/li\u003e\n\u003cli\u003eZhao X, Guo Q, Zhang X, et al. The urinary and sexual outcomes of buccal mucosal graft urethroplasty versus end-to-end anastomosis: a systematic review with meta-analysis. Sex Med. 2024;12(4):qfae064.\u003c/li\u003e\n\u003cli\u003eHermosa PC, Martins FE, et al. Sexual function after anterior urethroplasty: a systematic review. Transl Androl Urol. 2021;10(5):2134-45.\u003c/li\u003e\n\u003cli\u003eBlaschko SD, Sanford MT, Cinman NM, McAninch JW, Breyer BN. De novo erectile dysfunction after anterior urethroplasty: a systematic review and meta-analysis. BJU Int. 2013;112(5):655-63.\u003c/li\u003e\n\u003cli\u003eSoave A, Dahlem R, Pinnschmidt HO, et al. Outcome of buccal mucosa graft urethroplasty: a prospective evaluation. BMC Urol. 2019;19(1):44.\u003c/li\u003e\n\u003cli\u003eEissa A, El-Sayed M, Ghaly M, et al. Erectile and voiding function outcomes after buccal mucosa graft bulbar urethroplasty: a retrospective review of 232 patients. J Urol. 2023;209(3):557-65.\u003c/li\u003e\n\u003cli\u003eJordan GH, Schlossberg SM. Surgery of the penis and urethra. In: Wein AJ, Kavoussi LR, Partin AW, Peters CA, editors. Campbell-Walsh Urology. 12th ed. Philadelphia: Elsevier; 2021. p. 980-1002.\u003c/li\u003e\n\u003cli\u003ePang KH, Chapple CR, et al. Erectile and ejaculatory function following anterior urethroplasty: a systematic review. Eur Urol Focus. 2022;8(6):1499-507.\u003c/li\u003e\n\u003cli\u003ePalminteri E, Maruccia S, Berdondini E, et al. Long-term results of 1-stage penile urethroplasty using oral mucosal grafts. Eur Urol. 2018;73(3):485-92.\u003c/li\u003e\n\u003cli\u003eCoursey JW, Morey AF. Penile curvature after urethroplasty: incidence and management. Urology. 2002;60(5):864-7.\u003c/li\u003e\n\u003cli\u003eEkerhult TO, Lindqvist K, Peeker R. Long-term patient-reported sexual function after bulbar urethroplasty. Scand J Urol. 2015;49(5):374-9.\u003c/li\u003e\n\u003cli\u003eAbdel-al I, El-Shazly M, Hegazy A, et al. Erectile function after different techniques of bulbar urethroplasty: Does urethral transection make a difference? BMC Urol. 2023;23(1):140.\u003c/li\u003e\n\u003cli\u003eErickson BA, Granieri MA, Meeks JJ, Cashy JP, Gonzalez CM. Prospective analysis of erectile dysfunction after anterior urethroplasty: incidence and recovery of function. J Urol. 2010;183(2):657\u0026ndash;61. \u003c/li\u003e\n\u003cli\u003eD\u0026rsquo;hulst P, Muilwijk T, Vander Eeckt K, Van der Aa F, Joniau S. Patient-reported outcomes after buccal mucosal graft urethroplasty for bulbar urethral strictures: results of a prospective single-centre cohort study. BJU Int. 2020;126(6):684\u0026ndash;93. \u003c/li\u003e\n\u003cli\u003eShalkamy O, Elsalhy M, Alghamdi SM, et al. Erectile function after different techniques of bulbar urethroplasty: does urethral transection make a difference? BMC Urol. 2023; 23:140. \u003c/li\u003e\n\u003cli\u003eBlaschko SD, Sanford MT, Cinman NM, McAninch JW, Breyer BN. De novo erectile dysfunction after anterior urethroplasty: a systematic review and meta-analysis. BJU Int. 2013; 112:655\u0026ndash;663. \u003c/li\u003e\n\u003cli\u003eCoursey JW, Morey AF, McAninch JW, et al. Erectile function after anterior urethroplasty. J Urol. 2001; 166:2273\u0026ndash;6.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"buccal mucosal graft, urethroplasty, erectile function, sexual outcomes, complications","lastPublishedDoi":"10.21203/rs.3.rs-8492182/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8492182/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eObjective\u003c/h2\u003e \u003cp\u003eTo evaluate the sexual outcomes, including both benefits and complications, following buccal mucosal graft (BMG) urethroplasty in male patients.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA retrospective study was conducted on 160 patients came in the duration between February 2020 to December 2023 who underwent BMG urethroplasty for anterior urethral stricture longer than 3 cm. All patients were followed for a minimum of 2 years. Operative details, sexual function outcomes, and postoperative complications were recorded.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe mean age was 39\u0026thinsp;\u0026plusmn;\u0026thinsp;10.5 years old. Body mass index 27.3\u0026thinsp;\u0026plusmn;\u0026thinsp;4.2 kg/m\u0026sup2;. Diabetes Mellitus in 8 cases, Hypertension in 18 cases. Aetiology of stricture was iatrogenic trauma in 60% of cases, 20% inflammatory ,15% lichen sclerosus and 5% idiopathic stricture. Operative time was 180\u0026thinsp;\u0026plusmn;\u0026thinsp;25.6 minutes. Postoperative evaluation revealed significant improvement in international index of erectile function (IIEF-5) scores, indicating enhancement of erectile function in most patients. However, sexual complications were observed in a subset of cases: eight patients (5%) developed moderate erectile dysfunction, while five (3%) exhibited ventral penile curvature. Among those with curvature, three experienced spontaneous resolution, whereas two required surgical correction.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eBuccal mucosal urethroplasty generally leads to improved erectile function and favorable sexual outcomes. Nevertheless, moderate erectile dysfunction and ventral curvature may occur as infrequent complications that require appropriate evaluation and management.\u003c/p\u003e","manuscriptTitle":"Sexual Outcomes After Buccal Mucosal Graft Urethroplasty: Benefits and Complications","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-01-16 09:15:14","doi":"10.21203/rs.3.rs-8492182/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"3ac3cd94-9f4a-43e0-b9ba-27d8f7e3e9a4","owner":[],"postedDate":"January 16th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-01-30T22:08:58+00:00","versionOfRecord":[],"versionCreatedAt":"2026-01-16 09:15:14","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8492182","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8492182","identity":"rs-8492182","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}