To compare functional success and patient reported outcomes measures (PROM) after non-transecting anastomotic urethroplasty (NTAU) for management of lengthy (>2cm) and short (≤2cm) bulbar urethral strictures.
Patients undergoing NTAU for bulbar urethral strictures by a single surgeon from 2017-2024 were retrospectively reviewed. Urethral stricture recurrence was defined as need for repeat intervention. Stretched penile length (SPL) was collected pre- and post-operatively. A survey comprised of urinary and sexual patient reported outcome measures (PROMs) was collected. Outcomes were compared based on stricture length (>2cm versus ≤2cm) and location within the bulbar urethra (mid/proximal versus distal).
A total of 97 patients underwent NTAU for bulbar strictures [88% mid/proximal (n=85), 12% distal (n=12)] with a median stricture length of 1.7 (1-2.5) cm. One third (32/97) had lengthy (>2cm) strictures. Overall functional success was 96% at a median follow-up of 8.4 (3.5-15.8) months: 94% lengthy (30/32), 97% short (63/65). Survey response was 53% (51/97). There was no significant difference in 30-day complications (9% vs. 12%) or anastomotic leak on VCUG (9% vs. 3%) between lengthy and short strictures (all p>0.05). Lengthy strictures were associated with a greater reduction in SPL compared to short strictures (-4% vs. 0%; p=0.001). There was no significant difference in PROMs between groups, however, distal patients reported more angulation (57% vs. 12%, p=0.02) and subjective penile length loss (86% vs. 38%, p=0.04) postoperatively.
NTAU is an effective option for lengthy (>2cm) bulbar urethral strictures with high functional success and comparable postoperative sexual side effects observed with short strictures. Patients with distal strictures should be counseled regarding increased incidence of penile related side-effects such as angulation and perceived penile length loss.
Urology. 2026 Feb 03 [Epub ahead of print]
Bridget L Findlay, Nikolas Moring, Alex J Miller, Anthony Fadel, Alexandr M Pinkhasov, J Nicholas Warner, Katherine T Anderson, Boyd R Viers
Department of Urology, Mayo Clinic, Phoenix, AZ., Department of Urology, Mayo Clinic, Rochester, MN., Department of Urology, Mayo Clinic, Rochester, MN. Electronic address: .