{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,10]],"date-time":"2026-05-10T09:16:47Z","timestamp":1778404607488,"version":"3.51.4"},"reference-count":28,"publisher":"Springer Science and Business Media LLC","issue":"9","license":[{"start":{"date-parts":[[2021,3,11]],"date-time":"2021-03-11T00:00:00Z","timestamp":1615420800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,3,11]],"date-time":"2021-03-11T00:00:00Z","timestamp":1615420800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Universit\u00e4tsklinikum Hamburg-Eppendorf (UKE)"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["World J Urol"],"published-print":{"date-parts":[[2021,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Purpose<\/jats:title>\n                <jats:p>To evaluate the interplay of stricture recurrence, sexual function, and treatment satisfaction after substitution urethroplasty.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>Observational study of men undergoing 1-stage buccal mucosal graft urethroplasty for anterior urethral stricture between 2009 and 2016. Patients were dichotomized by self-reported treatment satisfaction. Sexual function was assessed by validated and non-validated patient-reported outcome measures. Functional recurrence was defined as symptomatic need of re-intervention. Bivariate analyses, Kaplan\u2013Meier estimates, qualitative and quantitative analyses by uni- and multivariable regression were employed to evaluate the interplay of sexual function, functional recurrence, and treatment satisfaction.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>Of 534 men with bulbar (82%), penobulbar (11%), and penile strictures (7.3%), 451 (84%) were satisfied with the surgery. There were no differences in stricture location, previous treatment, graft length, or surgical technique between satisfied and unsatisfied patients (all <jats:italic>p <\/jats:italic>\u2009\u2265\u2009 0.2). Recurrence-free survival was 85% at a median follow-up of 33 mo and decreased significantly with each Likert item towards increasing dissatisfaction (<jats:italic>p <\/jats:italic>\u2009&lt; \u20090.001). Dissatisfied patients more often reported postoperative loss of rigidity, tumescence, reduced ejaculatory volume, ejaculatory pain, and reduced penile length (all <jats:italic>p <\/jats:italic>\u2009\u2264\u2009 0.042). In 83 dissatisfied men, functional recurrence (28%) and oral morbidity (20%) were the main drivers of dissatisfaction in qualitative analysis. Multivariable analyses revealed functional recurrence and impaired postoperative ejaculatory function as independent predictors of treatment dissatisfaction (all <jats:italic>p <\/jats:italic>\u2009\u2264 \u20090.029) after adjusting for confounders.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>We found an association of both functional success and sexual function with patient-reported treatment satisfaction after substitution urethroplasty. Such findings validate the clinical significance of defining the symptomatic need for re-intervention as an endpoint and underline the importance of further research evaluating sexual function before and after open urethral reconstruction.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s00345-021-03648-y","type":"journal-article","created":{"date-parts":[[2021,3,11]],"date-time":"2021-03-11T18:02:48Z","timestamp":1615485768000},"page":"3533-3539","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Exploring the intersection of functional recurrence, patient-reported sexual function, and treatment satisfaction after anterior buccal mucosal graft urethroplasty"],"prefix":"10.1007","volume":"39","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5987-3883","authenticated-orcid":false,"given":"Malte W.","family":"Vetterlein","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Almut","family":"G\u00f6dde","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7881-9134","authenticated-orcid":false,"given":"Valentin","family":"Zumstein","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9113-5933","authenticated-orcid":false,"given":"Philipp","family":"Gild","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Phillip","family":"Marks","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Armin","family":"Soave","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1163-1401","authenticated-orcid":false,"given":"Christian P.","family":"Meyer","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Silke","family":"Riechardt","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Roland","family":"Dahlem","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Margit","family":"Fisch","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4629-4388","authenticated-orcid":false,"given":"Luis A.","family":"Kluth","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"name":"for the Trauma and Reconstructive Urology Working Party of the European Association of Urology Young Academic Urologists","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2021,3,11]]},"reference":[{"key":"3648_CR1","doi-asserted-by":"publisher","first-page":"2507","DOI":"10.1016\/S0022-5347(05)65015-X","volume":"167","author":"TM Kessler","year":"2002","unstructured":"Kessler TM, Fisch M, Heitz M, Olianas R, Schreiter F (2002) Patient satisfaction with the outcome of surgery for urethral stricture. J Urol 167:2507\u20132511","journal-title":"J Urol"},{"key":"3648_CR2","doi-asserted-by":"publisher","first-page":"777","DOI":"10.1016\/j.eururo.2013.04.037","volume":"64","author":"MJ Jackson","year":"2013","unstructured":"Jackson MJ, Chaudhury I, Mangera A et al (2013) A prospective patient-centred evaluation of urethroplasty for anterior urethral stricture using a validated patient-reported outcome measure. Eur Urol 64:777\u2013782","journal-title":"Eur Urol"},{"key":"3648_CR3","doi-asserted-by":"publisher","first-page":"48","DOI":"10.1007\/s11934-018-0797-9","volume":"19","author":"N Baradaran","year":"2018","unstructured":"Baradaran N, Hampson LA, Edwards TC, Voelzke BB, Breyer BN (2018) Patient-reported outcome measures in urethral reconstruction. Curr Urol Rep 19:48","journal-title":"Curr Urol Rep"},{"key":"3648_CR4","doi-asserted-by":"publisher","first-page":"1113","DOI":"10.1016\/j.juro.2017.05.077","volume":"198","author":"BN Breyer","year":"2017","unstructured":"Breyer BN, Edwards TC, Patrick DL, Voelzke BB (2017) Comprehensive qualitative assessment of urethral stricture disease: toward the development of a patient centered outcome measure. J Urol 198:1113\u20131118","journal-title":"J Urol"},{"key":"3648_CR5","doi-asserted-by":"publisher","first-page":"222","DOI":"10.1016\/j.urology.2018.12.009","volume":"126","author":"PH Chung","year":"2019","unstructured":"Chung PH, Vanni AJ, Breyer BN et al (2019) Evaluation of generic versus condition-specific quality of life indicators for successful urethral stricture surgery. Urology 126:222\u2013226","journal-title":"Urology"},{"key":"3648_CR6","doi-asserted-by":"publisher","first-page":"162","DOI":"10.1016\/j.urology.2020.02.034","volume":"141","author":"E Redmond","year":"2020","unstructured":"Redmond E, Bekkema J, Rourke K (2020) Comprehensive prospective assessment of patient-reported outcomes following urethroplasty. Urology 141:162\u2013167","journal-title":"Urology"},{"key":"3648_CR7","doi-asserted-by":"publisher","first-page":"453","DOI":"10.1016\/j.juro.2016.01.117","volume":"196","author":"LA Bertrand","year":"2016","unstructured":"Bertrand LA, Voelzke BB, Elliott SP et al (2016) Measuring and predicting patient dissatisfaction after anterior urethroplasty using patient reported outcomes measures. J Urol 196:453\u2013461","journal-title":"J Urol"},{"key":"3648_CR8","doi-asserted-by":"publisher","first-page":"974","DOI":"10.1016\/j.jsxm.2018.05.005","volume":"15","author":"A Kaluzny","year":"2018","unstructured":"Kaluzny A, Gibas A, Matuszewski M (2018) Ejaculatory disorders in men with urethral stricture and impact of urethroplasty on the ejaculatory function: a systematic review. J Sex Med 15:974\u2013981","journal-title":"J Sex Med"},{"key":"3648_CR9","doi-asserted-by":"publisher","first-page":"492","DOI":"10.1016\/j.sxmr.2017.09.002","volume":"6","author":"CR Benson","year":"2018","unstructured":"Benson CR, Hoang L, Clavell-Hernandez J, Wang R (2018) Sexual dysfunction in urethral reconstruction: a review of the literature. Sex Med Rev 6:492\u2013503","journal-title":"Sex Med Rev"},{"key":"3648_CR10","doi-asserted-by":"publisher","first-page":"234","DOI":"10.1016\/j.urology.2016.12.047","volume":"103","author":"CC Maciejewski","year":"2017","unstructured":"Maciejewski CC, Haines T, Rourke KF (2017) Chordee and penile shortening rather than voiding function are associated with patient dissatisfaction after urethroplasty. Urology 103:234\u2013239","journal-title":"Urology"},{"key":"3648_CR11","doi-asserted-by":"publisher","first-page":"S8","DOI":"10.1016\/j.urology.2013.09.011","volume":"83","author":"KW Angermeier","year":"2014","unstructured":"Angermeier KW, Rourke KF, Dubey D, Forsyth RJ, Gonzalez CM (2014) SIU\/ICUD consultation on urethral strictures: evaluation and follow-up. Urology 83:S8-17","journal-title":"Urology"},{"key":"3648_CR12","doi-asserted-by":"publisher","first-page":"563","DOI":"10.1016\/j.juro.2018.09.041","volume":"201","author":"MW Vetterlein","year":"2019","unstructured":"Vetterlein MW, Loewe C, Zumstein V et al (2019) Characterization of a standardized postoperative radiographic and functional voiding trial after 1-stage bulbar ventral onlay buccal mucosal graft urethroplasty and the impact on stricture recurrence-free survival. J Urol 201:563\u2013572","journal-title":"J Urol"},{"key":"3648_CR13","doi-asserted-by":"publisher","first-page":"1308","DOI":"10.1016\/j.juro.2018.06.067","volume":"200","author":"MW Vetterlein","year":"2018","unstructured":"Vetterlein MW, Stahlberg J, Zumstein V et al (2018) The impact of surgical sequence on stricture recurrence after anterior 1-stage buccal mucosal graft urethroplasty: comparative effectiveness of initial, repeat and secondary procedures. J Urol 200:1308\u20131314","journal-title":"J Urol"},{"key":"3648_CR14","doi-asserted-by":"publisher","first-page":"648","DOI":"10.1016\/j.urology.2004.05.011","volume":"64","author":"J Fichtner","year":"2004","unstructured":"Fichtner J, Filipas D, Fisch M, Hohenfellner R, Thuroff JW (2004) Long-term outcome of ventral buccal mucosa onlay graft urethroplasty for urethral stricture repair. Urology 64:648\u2013650","journal-title":"Urology"},{"key":"3648_CR15","doi-asserted-by":"publisher","first-page":"657","DOI":"10.1016\/S0090-4295(01)01377-2","volume":"58","author":"HS Asopa","year":"2001","unstructured":"Asopa HS, Garg M, Singhal GG, Singh L, Asopa J, Nischal A (2001) Dorsal free graft urethroplasty for urethral stricture by ventral sagittal urethrotomy approach. Urology 58:657\u2013659","journal-title":"Urology"},{"key":"3648_CR16","doi-asserted-by":"publisher","first-page":"1283","DOI":"10.1007\/s00345-019-02871-y","volume":"38","author":"V Zumstein","year":"2020","unstructured":"Zumstein V, Dahlem R, Kluth LA et al (2020) A critical outcome analysis of Asopa single-stage dorsal inlay substitution urethroplasty for penile urethral stricture. World J Urol 38:1283\u20131294","journal-title":"World J Urol"},{"key":"3648_CR17","doi-asserted-by":"publisher","first-page":"1444","DOI":"10.1111\/j.1464-410X.2009.08557.x","volume":"103","author":"S Riechardt","year":"2009","unstructured":"Riechardt S, Pfalzgraf D, Dahlem R, Fisch M (2009) Surgery illustrated\u2013focus on details: dorsal buccal mucosal inlay for penile urethroplasty. BJU Int 103:1444\u20131447","journal-title":"BJU Int"},{"key":"3648_CR18","doi-asserted-by":"publisher","first-page":"123","DOI":"10.1016\/S0022-5347(01)66566-2","volume":"155","author":"G Barbagli","year":"1996","unstructured":"Barbagli G, Selli C, Tosto A, Palminteri E (1996) Dorsal free graft urethroplasty. J Urol 155:123\u2013126","journal-title":"J Urol"},{"key":"3648_CR19","doi-asserted-by":"crossref","unstructured":"Kluth LA, Dahlem R, Becker A, et al. Psychometric validation of a German language version of a PROM for urethral stricture surgery and preliminary testing of supplementary ED and UI constructs. World J Urol 2016;34:369\u2013375.","DOI":"10.1007\/s00345-015-1610-8"},{"key":"3648_CR20","doi-asserted-by":"publisher","first-page":"777","DOI":"10.1016\/j.urology.2004.04.056","volume":"64","author":"RC Rosen","year":"2004","unstructured":"Rosen RC, Catania J, Pollack L, Althof S, O\u2019Leary M, Seftel AD (2004) Male sexual health questionnaire (MSHQ): scale development and psychometric validation. Urology 64:777\u2013782","journal-title":"Urology"},{"key":"3648_CR21","doi-asserted-by":"publisher","first-page":"2273","DOI":"10.1016\/S0022-5347(05)65549-8","volume":"166","author":"JW Coursey","year":"2001","unstructured":"Coursey JW, Morey AF, McAninch JW et al (2001) Erectile function after anterior urethroplasty. J Urol 166:2273\u20132276","journal-title":"J Urol"},{"key":"3648_CR22","doi-asserted-by":"publisher","first-page":"1511","DOI":"10.1016\/j.urology.2014.08.010","volume":"84","author":"MA Granieri","year":"2014","unstructured":"Granieri MA, Webster GD, Peterson AC (2014) Scrotal and perineal sensory neuropathy after urethroplasty for bulbar urethral stricture disease: an evaluation of the incidence, timing, and resolution. Urology 84:1511\u20131515","journal-title":"Urology"},{"key":"3648_CR23","doi-asserted-by":"publisher","first-page":"1266","DOI":"10.1016\/j.juro.2009.06.027","volume":"182","author":"JJ Meeks","year":"2009","unstructured":"Meeks JJ, Erickson BA, Granieri MA, Gonzalez CM (2009) Stricture recurrence after urethroplasty: a systematic review. J Urol 182:1266\u20131270","journal-title":"J Urol"},{"key":"3648_CR24","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.ucl.2016.08.001","volume":"44","author":"BA Erickson","year":"2017","unstructured":"Erickson BA, Ghareeb GM (2017) Definition of successful treatment and optimal follow-up after urethral reconstruction for urethral stricture disease. Urol Clin North Am 44:1\u20139","journal-title":"Urol Clin North Am"},{"key":"3648_CR25","doi-asserted-by":"publisher","first-page":"2763","DOI":"10.1007\/s00345-019-02653-6","volume":"37","author":"N Baradaran","year":"2019","unstructured":"Baradaran N, Fergus KB, Moses RA et al (2019) Clinical significance of cystoscopic urethral stricture recurrence after anterior urethroplasty: a multi-institution analysis from Trauma and Urologic Reconstructive Network of Surgeons (TURNS). World J Urol 37:2763\u20132768","journal-title":"World J Urol"},{"key":"3648_CR26","doi-asserted-by":"publisher","first-page":"213","DOI":"10.1016\/j.urology.2014.01.054","volume":"84","author":"BA Erickson","year":"2014","unstructured":"Erickson BA, Elliott SP, Voelzke BB et al (2014) Multi-institutional 1-year bulbar urethroplasty outcomes using a standardized prospective cystoscopic follow-up protocol. Urology 84:213\u2013217","journal-title":"Urology"},{"key":"3648_CR27","doi-asserted-by":"publisher","first-page":"891","DOI":"10.1016\/j.urology.2012.11.059","volume":"81","author":"E Palminteri","year":"2013","unstructured":"Palminteri E, Berdondini E, De Nunzio C et al (2013) The impact of ventral oral graft bulbar urethroplasty on sexual life. Urology 81:891\u2013898","journal-title":"Urology"},{"key":"3648_CR28","doi-asserted-by":"publisher","first-page":"395","DOI":"10.1016\/j.urology.2015.04.055","volume":"86","author":"DP Patel","year":"2015","unstructured":"Patel DP, Elliott SP, Voelzke BB et al (2015) Patient-reported sexual function after staged penile urethroplasty. Urology 86:395\u2013400","journal-title":"Urology"}],"container-title":["World Journal of Urology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00345-021-03648-y.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00345-021-03648-y\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00345-021-03648-y.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,10,13]],"date-time":"2021-10-13T01:41:55Z","timestamp":1634089315000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00345-021-03648-y"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,3,11]]},"references-count":28,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2021,9]]}},"alternative-id":["3648"],"URL":"https:\/\/doi.org\/10.1007\/s00345-021-03648-y","relation":{},"ISSN":["0724-4983","1433-8726"],"issn-type":[{"value":"0724-4983","type":"print"},{"value":"1433-8726","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,3,11]]},"assertion":[{"value":"29 December 2020","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"19 February 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"11 March 2021","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Compliance with ethical standards"}},{"value":"All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"Informed consent was obtained from all individual participants included in the study.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed consent"}},{"value":"All authors have no conflict of interest to disclose.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}}]}}