Posterior urethral strictures may develop due to previous surgeries, trauma-related urethral injuries, and other causes. In this video presentation, we aim to demonstrate the anastomotic urethroplasty procedure performed on a patient who had voiding difficulty after radical prostatectomy and subsequently underwent multiple surgical interventions for vesicourethral anastomotic stricture.

The patient had a history of an open radical prostatectomy performed at an another center in April 2023. Postoperatively, he experienced urinary retention and underwent a total of 7–8 endoscopic dilation procedures. The patient, who had not received any adjuvant treatment for prostate cancer and had PSA levels at negligible values, developed an anastomotic stricture and underwent urethral stent  placement within the same year. The stent was replaced a year later, and in September 2024, a migrated stent was removed. In November 2024, due to urinary retention, a suprapubic cystostomy was performed, followed by endoscopic catheter placement. At the time of presentation to our clinic, the patient had been catheterized urethral After completing preoperative preparations, the patient underwent surgery in January 2025. A guidewire was inserted through the existing catheter, which was then removed. Urethroscopy revealed a 2 cm-long stricture located approximately 1 cm distal to the mucosal margin of the bladder neck. A decision was made to perform urethroplasty. A perineal incision was made, and tissue layers were dissected appropriately. Urethral mobilization was performed up to the level of the stricture. To preserve the bulbar artery dorsally, a mucosal incision was made from the 12 o’clock to the 6 o’clock position. The stenotic segment was excised, and anastomotic urethroplasty was performed over a 16 Fr Foley catheter. A Hemovac drain was placed, and the procedure was completed without complications.

No complications were observed during follow-up. The patient was discharged with a catheter on the 5th postoperative day with appropriate recommendations.

In posterior urethral strictures, urethroplasty may be a viable surgical option depending on the location of the stricture. However, careful patient selection and thorough preoperative and perioperative evaluation are crucial for optimal outcomes.