- Design
- Systematic review and meta-analysis of 11 observational studies
- Population
- 669 men with bulbomembranous strictures after BPH surgery (417 in pooled analysis)
- Primary outcome
- Patency and new urinary incontinence after urethroplasty
- Effect
- Patency 90% (95% CI 85–93%); new incontinence 5% (3–10%)
This systematic review and meta-analysis collected 11 observational studies, 669 men, of urethroplasty for bulbomembranous or proximal bulbar strictures after endoscopic BPH surgery; nine studies with 417 men were pooled.
Pooled patency was about 90%, though in most studies this meant freedom from further intervention rather than confirmed anatomical patency. Anastomotic urethroplasty reached about 94% and ventral onlay buccal graft about 87%, but with only three and four studies respectively, technique comparisons are unreliable. New urinary incontinence occurred in about 5%. Erectile function data were too sparse to pool, though the two studies that measured it found no clear decline.
These strictures sit close to the sphincter, and many men are offered repeated dilatation or urethrotomy because of fear of incontinence. This review suggests that, in experienced centres, definitive repair succeeds in most and rarely causes new incontinence.
The studies were at moderate to serious risk of bias and came from specialist units, so results may not transfer to lower-volume practice.
- Consider referral for urethroplasty rather than repeated dilatation for post-BPH bulbomembranous strictures.
- Counsel that about 1 in 20 men developed new incontinence after repair.
- Refer to centres with reconstructive urethral experience.
- Record continence and erectile function before repair to judge change.
- Image the stricture length and location before planning surgery.
Why it matters
Fear of sphincter damage keeps many men on a cycle of dilatations that definitive repair could end.
Don't overread it
Observational, specialist-centre data with inconsistent definitions; it does not establish which technique is best.
The statistics, in plain English
Patency of 90% (85–93%) mostly means no further procedure was needed, which can overstate success if some men were not re-examined. Technique-specific figures come from very few studies, so differences between them may be chance.
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