Stricture Excision and Primary Anastomosis for Anterior Urethral Strictures

Abstract

Stricture excision and primary end-to-end anastomosis is the most durable surgical treatment for anterior urethral strictures. After resecting all fibrotic urethral walls, proximal and distal urethral ends are mobilized so they can be approximated without tension to bridge the gap. Natural urethral elasticity is used to elongate the urethra, and the distance can be shortened by opening the inter-crural septum. A wide mucosa-to-mucosa, tension-free anastomosis is then performed using fine interrupted absorbable sutures. This procedure is ideally suited for bulbar strictures 1–3 cm long, but it can also be successful in some selected cases with proximal bulbar strictures up to 5 cm in length. Because the anterior penile urethra is stretched during erection, this procedure is limited in the penile urethra, as it can produce shortening of the urethra and ventral curvature of the penis on erection. Complications are rare, mainly infection or hematoma of the operative wound. Sterile urine at the time of surgery and meticulous hemostasis are required to avoid them. Late failures are related to excessive tension at the anastomosis or incomplete fibrous resection. Complete excision of the fibrotic urethra is essential, and the surgeon must be prepared to perform an alternative form of repair if this resection results in a defect too long for a tension-free end-to-end reconstruction. When performed properly, excision and primary anastomosis is a well-tolerated, low-morbidity, and highly effective procedure, with an average long-term cure rate of over 90 %.