Pan-urethral strictures following endoscopic prostate surgeries, such as Holmium Laser Enucleation of the Prostate (HoLEP), present a reconstructive challenge due to the length of the segment involved and the patient's age. We present the case of a 72-year-old male with a history of Diabetes Mellitus and Coronary Artery Disease. Initially scheduled for a TURP in 2024 for BPH, an incidental urethral stricture was detected during endoscopy. Despite a prior internal urethrotomy and subsequent management with intermittent catheterization, the patient developed a symptomatic, long-segment pan-urethral stenosis, leading to a significant decline in voiding function and quality of life.

The diagnostic evaluation confirmed the complexity of the stricture:Uroflowmetry: Showed severely obstructed flow rates Qmax: 3 ml/s, Qavg: 3 ml/s with a significant Post-Void Residual (PVR) of 150 cc. Retrograde Urethrography (RUG): Confirmed a pan-urethral stenosis involving both the penile and bulbar segments.The surgical strategy chosen was a Single-Stage Dorsolateral Buccal Mucosal Graft (BMG) Urethroplasty, specifically utilizing the Kulkarni Technique. This approach involves a single perineal incision to access the entire urethra, followed by a one-sided (dorsolateral) mobilization of the urethra to preserve the contralateral neurovascular supply, providing a stable bed for the long BMG.

The procedure was successfully performed with a long buccal mucosal graft harvested from the inner cheek. Surgical Outcome: The single-stage approach allowed for complete reconstruction of the pan-urethral segment without the need for multiple stages or extensive penile skin incisions. Post-operative Recovery: No major perioperative complications were observed despite the patient’s comorbidities (DM and CAD).Voiding Function: At the follow-up, the patient reported a significant improvement in urine flow. Post-operative uroflowmetry demonstrated normalized flow rates, and the need for intermittent catheterization was completely eliminated.

The Kulkarni technique using a dorsolateral buccal mucosal graft is an excellent, definitive solution for long-segment and pan-urethral strictures occurring after HoLEP or other endoscopic interventions. This single-stage procedure offers several advantages:
Preservation: It protects the unilateral blood supply and nerves of the urethra. Efficiency: It avoids the morbidity and prolonged treatment time associated with multi-stage repairs. Reliability: It provides high success rates even in elderly patients with metabolic comorbidities.

Kulkarni, S., et al. (2009). "Single-stage Urethroplasty for Panurethral Strictures: The Kulkarni Technique." Journal of Urology.
Lumen, N., et al. (2015). "Panurethral Strictures: Etiology, Management, and Outcomes." Urology Practice.
Warner, J. N., et al. (2015). "The Management of Long-Segment Urethral Strictures with Buccal Mucosal Graft." Current Urology Reports.

Continence 19S (2026) 102737
DOI: 10.1016/j.cont.2026.102737