World Journal of Urology

, Volume 37, Issue 11, pp 2473–2479 | Cite as

Repair of sphincter urethral strictures preserving urinary continence: surgical technique and outcomes

  • Guido Barbagli
  • Sanjay B. Kulkarni
  • Pankaj M. Joshi
  • Dmitriy Nikolavsky
  • Francesco Montorsi
  • Salvatore Sansalone
  • Carla Loreto
  • Massimo LazzeriEmail author
Original Article



Repair of post-TURP sphincter urethral strictures represents challenging problem, due to the risk of urinary incontinence after the repair. We described a surgical technique we use to repair these strictures preserving urinary continence in patients with incompetent bladder neck.

Materials and methods

An observational, retrospective, study was conducted to include patients with post-TURP urethral strictures in the area of distal sphincter. We included only patients with complete clinical data and follow-up who previously underwent TURP or HOLEP or TUIP, and subsequently developed proximal bulbar urethral strictures close to the membranous urethra and the related distal urethral sphincter. Patients were included, if they were fully continent after TURP or other procedures to treat BPH. The primary outcome of the study was treatment failure, defined as the need for any post-operative instrumentation. Secondary outcome was post-urethroplasty urinary continence. Patients showing stricture recurrence or post-operative incontinence were classified as failure.


Overall, 69 patients were included in the study. Median patient’s age was 67 years; median stricture length was 4 cm. Thirty-tree patients (47.8%) underwent previous urethrotomy. Median follow-up was 52 months. Out of 69 patients, 55 (79.7%) were classified as success and 14 (20.3%) as failure. Out of the whole cohort, thus, 11/69 (16%) have a risk of recurrent strictures and 3/69 (4.3%) have incontinence.


The use of modified ventral onlay graft urethroplasty, using particular non-aggressive steps, is a suitable surgical technique for repair of sphincter urethral stricture in patients who underwent BPH transurethral surgery, using different procedures (TURP, HOLEP, TUIP).


Urethral stricture Urinary incontinence Urethroplasty TURP 



  1. 1.
    Rassweiler J, Teber D, Kuntz R, Hofmann R (2006) Complications of transurethral resection of the prostate (TURP)—incidence, management, and prevention. Eur Urol 50:969–980CrossRefGoogle Scholar
  2. 2.
    Kulkarni SB, Joglekar O, Alkandari M, Jhosi PM (2018) Management of post TURP strictures. World J Urol. CrossRefPubMedGoogle Scholar
  3. 3.
    Fenton AS, Morey AF, Aviles R, Garcia CR (2005) Anterior urethral strictures: etiology and characteristics. Urology 65:1055–1058CrossRefGoogle Scholar
  4. 4.
    Lumen N, Hoebeke P, Willemsen P, De Troyer B, Pieters R, Oosterlinck W (2009) Etiology of urethral strictures disease in 21st centrury. J Urol 182:983–987CrossRefGoogle Scholar
  5. 5.
    Heynes CF, van der Merwe J, Basson J, van der Merve A (2012) Etiology of male urethral strictures—evaluation of temporal changes at a single center, and review of the literature. Afr J Urol 18:4–9CrossRefGoogle Scholar
  6. 6.
    Komura K, Inamoto T, Takai T et al (2015) Incidence of urethral stricture after bipolar transurethral resection of the prostate using TURis: results from a randomized trial. BJU Int 115:644–652CrossRefGoogle Scholar
  7. 7.
    Blakely S, Caza T, Landas S, Nikolawski D (2016) Dorsal onlay urethroplasty for membranous urethral strictures: urinary and erectile functional outcomes. J Urol 195:1501–1507CrossRefGoogle Scholar
  8. 8.
    Mundy AR (1989) The treatment of sphincter strictures. BJU 64:626–628CrossRefGoogle Scholar
  9. 9.
    Morey AF, McAninch JW (1996) When and how to use buccal mucosa grafts in adult bulbar urethroplasty. Urology 48:194–198CrossRefGoogle Scholar
  10. 10.
    Barbagli G, Sansalone S, Romano G, Lazzeri M (2011) Sugery ilustrated—surgical atlas—ventral onlay oral mucosal graft bulbar urethroplasty. BJU 108:1218–1231CrossRefGoogle Scholar
  11. 11.
    Barbagli G, Montorsi F, Guazzoni G et al (2013) Ventral oral mucosal graft urethroplasty in nontraumatic bulabr urethral strictures: surgical technique and multivariable analysis of the results. Eur Urol 64:440–447CrossRefGoogle Scholar
  12. 12.
    Wang XD, Liu S, Xiong LX, Sun PY, Wang XS (2014) Normal anatomy of urethral sphincter complex in young Chinese males on MRI. Int Urol Nephrol 46:1469–1476CrossRefGoogle Scholar
  13. 13.
    Strasser H, Bartsch G (2000) Anatomy and innervation of the rhabdosphincter of the male urethra. Semin Urol Oncol 18:2–8PubMedGoogle Scholar
  14. 14.
    Oelrich TM (1980) The urethral sphincter muscle in the male. Am J Anat 158:229–246CrossRefGoogle Scholar
  15. 15.
    Hollabaugh RS Jr, Dmochowski RR, Steiner MS (1997) Neuroanatomy of the male rhabdosphincter. Urology 49:426–434CrossRefGoogle Scholar
  16. 16.
    Strasser H, Klima G, Poisel S, Horninger W, Bartsh G (1996) Anatomy and innervation of the rhabdosphincter of the male urethra. Prostate 28:24–31CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Guido Barbagli
    • 1
  • Sanjay B. Kulkarni
    • 2
  • Pankaj M. Joshi
    • 2
  • Dmitriy Nikolavsky
    • 3
  • Francesco Montorsi
    • 4
  • Salvatore Sansalone
    • 5
  • Carla Loreto
    • 6
  • Massimo Lazzeri
    • 7
    Email author
  1. 1.Centro Chirurgico ToscanoArezzoItaly
  2. 2.Kulkarni Reconstructive Urology CenterPuneIndia
  3. 3.Departments of Urology and Pathology, SyracuseState University of New York Upstate Medical UniversityNew YorkUSA
  4. 4.Division of Oncology, Unit of Urology, Urological Research InstituteIRCCS Ospedale San RaffaeleMilanItaly
  5. 5.Department of Experimental Medicine and SurgeryUniversity of Tor VergataRomeItaly
  6. 6.Department of Biomedical and Biotechnological Sciences, Section of Anatomy and HistologyUniversity of CataniaCataniaItaly
  7. 7.Istituto Clinico Humanitas IRCCS, Clinical and Research Hospital (ML)RozzanoItaly

Personalised recommendations