A Prospective Study of Patient-reported Pain After Bulbar Urethroplasty


      To understand the prevalence of chronic perineal pain, activity limitations, and patient satisfaction after urethroplasty.


      From 2014 to 2016, we prospectively enrolled men undergoing urethroplasty for bulbar urethral strictures. Patients, before and after surgery, completed questions from the Core Lower Urinary Tract Symptom Score assessing pain frequency in the bladder and penis or urethra, as well as nonvalidated questions assessing perineal pain. Overall satisfaction with their current urinary condition and pain-related activity limitations at home, work, or during exercise were also measured. Patients with <3 months of follow-up were excluded. Pre-and postoperative scores were compared using the Wilcoxon signed-rank test.


      Thirty-five men were included in the study. Mean age and body mass index were 44.6 years and 30.9 kg/m2, respectively. Urethroplasties were anastomotic in 24 (69%) and were single-stage buccal graft substitution in 11 (31%). Median follow-up after surgery was 483 days (range: 90-810 days). A total of 10 patients (29%) reported worsening perineal pain intensity after surgery, whereas 8 (23%) reported improvement and 17 (48%) reported no change. Overall, pain frequency in the bladder, penis or urethra, and perineum improved. Home and exercise pain-related activity restrictions improved significantly after surgery. Satisfaction with current urinary condition also improved with 91% reporting feeling “delighted,” “pleased,” or “mostly satisfied” with their current condition.


      Patients are highly satisfied with their urinary condition after urethroplasty. Pain frequency in the bladder and the urethra significantly improves after urethroplasty; however, perineal pain intensity can worsen and become chronic after surgery in some patients.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Urology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Santucci R.A.
        • Joyce G.F.
        • Wise M.
        Male urethral stricture disease.
        J Urol. 2007; 177: 1667-1674
        • Gallegos M.A.
        • Santucci R.A.
        Advances in urethral stricture management.
        F1000Res. 2016; 5: 2913
        • Mundy A.R.
        • Andrich D.E.
        Urethral strictures.
        BJU Int. 2011; 107: 6-26
        • Bertrand L.A.
        • Warren G.J.
        • Voelzke B.B.
        • et al.
        Lower urinary tract pain and anterior urethral stricture disease: prevalence and effects of urethral reconstruction.
        J Urol. 2015; 193: 184-189
        • Hampson L.A.
        • Elliott S.P.
        • Erickson B.A.
        • et al.
        Multicenter analysis of urinary urgency and urge incontinence in patients with anterior urethral stricture disease before and after urethroplasty.
        J Urol. 2016; 196: 1700-1705
        • Osterberg E.C.
        • Murphy G.
        • Harris C.R.
        • et al.
        Cost-effective strategies for the management and treatment of urethral stricture disease.
        Urol Clin North Am. 2017; 44: 11-17
        • Bertrand L.A.
        • Voelzke B.B.
        • Elliott S.P.
        • et al.
        Measuring and predicting patient dissatisfaction after anterior urethroplasty using patient reported outcomes measures.
        J Urol. 2016; 196: 453-461
        • Granieri M.A.
        • Webster G.D.
        • Peterson A.C.
        Scrotal and perineal sensory neuropathy after urethroplasty for bulbar urethral stricture disease: an evaluation of the incidence, timing, and resolution.
        Urology. 2014; 84: 1511-1515
        • Homma Y.
        • Yoshida M.
        • Yamanishi T.
        • et al.
        Core Lower Urinary Tract Symptom score (CLSS) questionnaire: a reliable tool in the overall assessment of lower urinary tract symptoms.
        Int J Urol. 2008; 15: 816-820
        • Dindo D.
        • Demartines N.
        • Clavien P.A.
        Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey.
        Ann Surg. 2004; 240: 205-213
        • Erickson B.A.
        • Elliott S.P.
        • Voelzke B.B.
        • et al.
        Multi-institutional 1-year bulbar urethroplasty outcomes using a standardized prospective cystoscopic follow-up protocol.
        Urology. 2014; 84: 213-216
        • Maciejewski C.C.
        • Haines T.
        • Rourke K.F.
        Chordee and penile shortening rather than voiding function are associated with patient dissatisfaction after urethroplasty.
        Urology. 2017; 103: 234-239
        • Jackson M.J.
        • Chaudhury I.
        • Mangera A.
        • et al.
        A prospective patient-centred evaluation of urethroplasty for anterior urethral stricture using a validated patient-reported outcome measure.
        Eur Urol. 2013; 64: 777-782
        • Dogra P.N.
        • Singh P.
        • Nayyar R.
        • et al.
        Sexual dysfunction after urethroplasty.
        Urol Clin North Am. 2017; 44: 49-56