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Urethroplasty for Urethral Stricture

Reconstructive Surgery for Urethral Narrowing

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Üroloji department. Book Appointment →

What is Urethroplasty for Urethral Stricture?

Open surgical urethral reconstruction; gold standard for urethral strictures.

Two main types: anastomotic urethroplasty (excision and primary anastomosis, EPA) for short bulbar strictures, and substitution urethroplasty (using grafts/flaps) for longer strictures.

Common graft material: buccal mucosal graft (BMG) — superior properties.

Long-term success >85-90% in expert hands, vs ~50% for repeated dilations/internal urethrotomy.

Symptoms

Targeted symptoms: weak urinary stream, straining, post-void dribbling.
Recurrent UTIs, urinary retention.
Bladder stones, decreased bladder compliance.
Spraying or splitting of urinary stream.
Failed dilation/internal urethrotomy.

Risk Factors

Etiology: trauma (straddle injury, pelvic fracture), infection (gonococcal), iatrogenic (catheterization, instrumentation), lichen sclerosus, idiopathic.
Recurrence risk: lichen sclerosus, longer strictures (>2 cm), failed prior treatment.
Smoking impairs graft take.
Diabetes, hypogonadism affect outcomes.

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Recurrent stricture after dilation/DVIU (>2 failed attempts).
  • Long stricture (>2 cm).
  • Stricture in pendulous urethra (poorly suited to internal urethrotomy).
  • Lichen sclerosus-related stricture.
  • Bladder stones or upper tract changes from obstruction.

Treatment Methods

01
Preoperative evaluation: retrograde urethrogram + voiding cystourethrogram, cystoscopy, uroflowmetry, ultrasound.
02
Short bulbar stricture (<2 cm): excision and primary anastomosis (EPA) — best outcomes.
03
Longer bulbar stricture: dorsal onlay (Asopa, Barbagli) or ventral onlay buccal mucosal graft.
04
Penile urethral stricture: dorsal onlay BMG; staged urethroplasty (Bracka) for complex cases (lichen sclerosus, hypospadias failures).
05
Posterior urethral distraction injuries: progressive perineal approach with EPA after pelvic fracture.
06
Postoperative: urinary catheter 14-21 days, voiding cystourethrogram before removal.
07
Avoid sexual activity 6 weeks; perineal trauma avoidance.
08
Long-term follow-up: uroflowmetry, residual, PVR, RUG if symptoms recur.

Which Department to Visit?

You can visit our Üroloji department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.