Repair of Multiple Urethral Strictures with Three Different Surgical Techniques (Dorsolateral Kulkarni, Anastomotic Urethroplasty, and Double-Face Urethroplasty)

KUCUKER K1, AYBEK Z1, DURAN M1, ERDOGAN M1, YATAGAN O1

Research Type

Clinical

Abstract Category

Urethra Male / Female

Abstract 304
Surgical Videos 3
Scientific Podium Video Session 26
Saturday 20th September 2025
14:22 - 14:30
Parallel Hall 2
Male Anatomy Surgery
1. Pamukkale University , School of Medicine , Urology Department , Denizli , Turkey
Presenter
Links

Abstract

Introduction
In the treatment of urethral stricture, physical examination, patient history, and various imaging methods play a crucial role in the management of the surgical process. The aim of this study is to evaluate how preoperative magnetic resonance imaging (MRI) findings of the urethra guide the use of different surgical techniques applied postoperatively. Additionally, the discussion will cover how different techniques can be utilized for the same case during surgery and the importance of preoperative patient evaluation.
Design
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.
Results
The operation duration was recorded as 5 hours, with a blood loss of 100 cc. On postoperative day 21, after clamping the cystofix, the catheter was removed. In the uroflowmetry control, the patient’s peak flow rate was measured as 19 ml/s.
Conclusion
In complicated urethral strictures, preoperative urethral MRI imaging was observed to play a significant guiding role in the surgical process. In this case, an additional stricture segment, which was not identified on the MRI, was detected during surgery and appropriately repaired with suitable surgical techniques. The postoperative control demonstrated satisfactory surgical success and urine flow rate. This study highlights that in complex urethroplasty cases, MRI imaging contributes significantly to the determination of the surgical strategy.
Disclosures
Funding No additional funding or grant was needed for the study. Clinical Trial No Subjects Human Ethics not Req'd Patient data were evaluated retrospectively and anonymously Helsinki Yes Informed Consent Yes
12/07/2025 10:44:13