Patient-reported outcomes on urethroplasty's effects on ejaculatory function.

Background: Urethroplasty may influence ejaculatory function due to the potential for nerve injury during perineal dissection. It is essential to understand postoperative ejaculatory outcomes for effective patient counseling and surgical planning. Objectives: To compare ejaculatory function and satisfaction following excision and primary anastomosis (EPA) versus substitution urethroplasty (SU), and to identify independent predictors of these outcomes. Design: Retrospective cohort study. Methods: A total of 63 sexually active men who underwent anterior urethroplasty between July 2017 and July 2022 at two tertiary centers were evaluated. Group I (EPA, n = 33) underwent transecting end-to-end urethroplasty, while Group II (SU, n = 30) underwent substitution urethroplasty utilizing buccal mucosa grafts. Ejaculatory function and satisfaction were assessed using the Male Sexual Health Questionnaire (MSHQ). Results: The mean stricture length was 3.3 ± 7 cm, and the overall urethroplasty success rate was 87% after a mean follow-up of 45.6 ± 21 months. The mean score on the MSHQ Erection Scale differed significantly between groups (EPA = 10.13 ± 4.66 vs SU = 12.69 ± 3.12, p = 0.008). Conversely, scores on the Ejaculation Scale (EPA = 27.24 ± 7.63 vs SU = 27.57 ± 6.84, p = 0.443) and Satisfaction Scale (EPA = 24.17 ± 6.73 vs SU = 25.79 ± 5.64, p = 0.790) were comparable. Multivariate analysis identified age as the sole independent predictor of Ejaculation Scale scores (β = -0.219, 95% CI: -0.351 to -0.087, p = 0.001). Conclusion: Postoperative ejaculatory function showed no significant difference between EPA and SU urethroplasty. Younger age was associated with improved ejaculatory outcomes, whereas no surgical or stricture-related factors predicted patient satisfaction. These findings underscore the importance of considering patient age during postoperative counseling and expectation management.