A 59-year-old male patient who developed external urinary tract stricture following a work-related accident 40 years ago and had undergone a total of 4 endoscopic dilation treatments was followed up with cystostomy for a prolonged period. The patient had no additional comorbidities. Preoperative urethral MRI was performed, which showed focal fibrotic stenotic-occlusive lesions about 7 mm in length at two levels: 4 cm and 7 cm distal from the external meatus in the penile urethra. The proximal penile urethra, bulbous urethra, and membranous urethra were observed to be patent. The proximal and middle sections of the prostatic urethra were open, but the lumen expansion was insufficient in a 7 mm long segment of the distal prostatic urethra. Additionally, bilateral kidney stones were detected in the patient. After completing the preoperative preparations, the patient was planned to undergo urethroplasty and bilateral long-term DJ stent placement.
After performing retrograde urethrography in the perioperative period, no contrast passage was seen from the mid-penile urethra to the proximal section of the urethra. A complete obliterative stricture was observed 4 cm proximal to the external meatus through endoscopic access. Following a coronal incision of the penis to deglove the tissue, the urethra was freed. A complete obliterative stricture was found approximately 3 cm proximally from the first stricture segment, and two non-obliterative stricture segments, totaling 3 cm in length, were detected from the proximal bulbar urethra to the external sphincter. Urethrolysis was performed on all these strictures, and dilation was applied to the non-obliterative stricture in the bulbar urethra extending to the external sphincter using a 14F dilator. In the patient with bilateral kidney stones, endoscopic access revealed that the orifices were deformed and laterally positioned. The right orifice was catheterized, and retrograde pyelography was performed to confirm tract safety, followed by the placement of a ureteral DJ stent. The same procedure was applied to the left kidney. Subsequently, a 6 cm graft was harvested from the buccal mucosa, and dorsolateral Kulkarni technique was applied to the bulbar urethra, double-face urethroplasty was applied to the mid-urethra, and anastomotic urethroplasty was performed on the distal stricture segment. Finally, a 14F silicone catheter was placed, and the skin and subcutaneous tissues were properly closed. A compressive dressing was applied, and the procedure was completed without complications.