Ariel Fredrick, Bradley A. Erickson, Kristian Stensland, Alex J. Vanni

Bulbar urethroplasty outcomes studies have shown low, but significant, rates of post- void dribbling (PVD) and ejaculatory dysfunction. The bulbospongiosus muscle is involved with expulsion of seminal fluid and urine from the bulbar urethra, and thus we hypothesized that performing urethroplasty utilizing a technique that does not split the muscle may result in better post-operative patient reported ejaculatory function (EF) and less PVD. We performed a multi-institutional matched, case-control analysis comparing men who underwent a bulbospongiosus sparing (BS) technique to men that had undergone the traditional non-bulbospongiosus sparing (non-BS) technique. Pre- and post-operatively (3-12 months) EF was assessed using the 4 ejaculatory questions of the Male Sexual Health Questionnaire (MSHQ) short form, as well as with a patient perception questionnaire. Post-void dribbling was assessed using a validated urethroplasty questionnaire. 25 BS and 25 NBS patients were matched by total pre-operative MSHQ score, age and performance of EPA. BS and non-BS groups had similar post-operative total MSHQ scores (15.24 vs. 15.40 respectively, p=0.90) and there were no significant post- operative MSHQ changes in either group (BS; 14.56 to 15.24, p=0.4 non-BS; 14.64 vs. 15.40, p=0.44). Individual MSHQ questions were analyzed between groups and not found to have a statistically significant difference. Rates of post-operative PVD and perception of EF were similar between the two groups. Sparing the bulbospongiosus muscle during urethroplasty does not seem to have a significant impact on patient reported EF or PVD compared with non-bulbospongiosus sparing urethroplasty at early follow-up.