The Urethroplasty Evolution and Rise of the Non-transecting Techniques for Bulbar Urethral Strictures

Urethral stricture disease is a relatively common urologic condition with an estimated incidence of 9/100,000 men younger than 65 years. The risk of stricture is markedly increased in patients older than 65 years with an incidence of 21/100,000, which is almost half the incidence for urolithia-sis in this population. This indicates the importance and high burden of strictures. 1 Symptomatic patients typically present withobstructiveurinarysymptoms(e.g.,incompleteemptying, straining, weak stream, etc.) and occasionally have a history of recurrent infections, hematuria, bladder stones, or renal failure. 2 More than half of strictures arise in bulbar urethra. 3 Urethroplasty is the preferred treatment for urethral stricture in most cases. It is underused compared to endo-scopic management. 4 The optimal surgical technique for bulbar urethral strictures continues to be an area of much debate among reconstructive urologists. Excision and primary anastomosis (EPA) via a perineal incision is historically the gold standard for short bulbar strictures ( < 2cm). In cases of longer strictures ( > 2cm), substitution techniques can be used. Some have shown excellent results using EPA in longer proximal bulbar strictures. 5 Previous series have reported an almost perfect long-term success rate of 90.8 to 98.8% with EPA. 6,7 Complete resection of fi brotic tissues is achievedwith EPA. This is particularly bene fi cial in traumatic strictures where the vascular density