Urethral strictures present a persistent challenge in urology, often requiring repeated interventions. Traditional treatments, including direct vision internal urethrotomy (DVIU) and open urethroplasty, have limitations such as high recurrence rates and significant morbidity. Endourethroplasty has emerged as a promising minimally invasive alternative, combining the benefits of endoscopic intervention with improved graft-based tissue integration. This study evaluates the efficacy and safety of a novel two-step endourethroplasty technique for managing urethral strictures.

Study Design A prospective study was conducted involving 10 patients diagnosed with urethral strictures, all of whom underwent endourethroplasty. The procedure was executed in a two-step manner. Surgical Technique Step 1: DVIU was performed using a 21Fr urethrotome at the 12 o’clock position, extending 180 to 240 degrees. Serial dilations were then performed using metal dilators up to 28Fr. The length and location of the stricture were measured from the bladder neck using a cystoscope. Step 2: A tubularized skin graft was prepared and fixed to a 20Fr Foley catheter just below the balloon using rapidly absorbing 4-0 polyglycolic acid sutures. The catheter, along with the graft, was retrogradely inserted into the bladder and positioned at the stricture site. The catheter was secured, and the graft was left in place for three weeks to allow epithelialization. Postoperatively, the catheter was removed, and urethroscopy was performed to assess graft uptake and urethral patency. Follow-up assessments were conducted at 3, 6, and 12 months, evaluating uroflowmetry, symptom scores, and complication rates.

Results Success Rate: 90% urethral patency was maintained in our cases at 12 months followup, with 1 pt requiring urethral dilatation at 12months. Peak Flow Rate: The average peak urinary flow rate increased by 20 mL/s postoperatively. Complications: Minimal adverse events were observed, with no major complications reported. Quality of Life Improvement: Significant enhancement in patient-reported quality of life post-procedure (p < 0.05).

Endourethroplasty represents a promising, minimally invasive option for the management of urethral strictures. By combining the advantages of DVIU and open urethroplasty, this technique offers reduced morbidity and lower recurrence rates while achieving outcomes comparable to open urethroplasty. The findings indicate successful urethral patency, improved urinary flow, and enhanced patient quality of life. However Further research involving larger patient cohorts is warranted to validate these results.