Feasibility and surgical outcomes of simultaneous urethral reconstruction for synchronous urethral strictures.

Objectives: To evaluate the feasibility and surgical outcomes of simultaneous urethral reconstruction for synchronous urethral strictures (SUS) and analyze the surgical techniques employed for different stricture combinations.

Methods: Twenty-two male patients with SUS who underwent urethral reconstruction between February 2018 and July 2023 were retrospectively reviewed. Stricture locations and lengths were evaluated using cystoscopy and urethrography after urethral rest for at least 3 months. Multiple reconstruction techniques were employed based on stricture characteristics, including anastomotic urethroplasty, substitution urethroplasty, staged urethroplasty, perineal urethrostomy, and deep lateral incision of the bladder neck. Anatomical success was defined as the ability to pass a cystoscope without resistance and void without additional interventions.

Results: The median age was 72, with iatrogenic causes accounting for 77.2%. The most common stricture combination was strictures at the penoscrotal junction and proximal bulbar urethra (59.1%). Two (9.1%) had strictures in three locations, and one (4.5%) had strictures in four locations. A total of 15 different combinations of reconstruction techniques were utilized to address various stricture patterns. Overall, 86.4% were treated in one stage. The median operation time was 177 min, and the median blood loss was 72 mL. At a median follow-up of 31 months, anatomical success was achieved at 77.3%. No perioperative complications were observed.

Conclusions: Simultaneous repair of SUS is feasible using various reconstructive techniques tailored to each stricture site. The high prevalence of iatrogenic etiology and previous transurethral treatments emphasize the importance of appropriate initial management of urethral strictures.