For a patient with a history of failed anterior urethroplasty, a one-sided anterior urethroplasty can be a viable option for reconstruction, potentially preserving the vascular supply and achieving a high success rate. We present our adoption of this technique for a patient who developed a urethral stricture following a urethroplasty that was previously performed for a bulbar urethral fistula.

Our patient is a 56-year-old gentleman who had initially presented with recurrent perineal abscesses and was found to have bulbs-urethral cutaneous fistula based on urethrogram. He underwent an anterior substitution urethroplasty with successful voiding outcomes but was lost to follow up post-operatively. He presented 4 years after with worsening urinary flow (maximum flow rate [Qmax]: 7.4ml/s) and recurrent urinary tract infections. Assessment with cystoscopy and urethrogram confirmed an anterior (penile) urethral stricture. The patient subsequently underwent an elective one-sided anterior urethroplasty and suprapubic catheter insertion (SPC).

Intraoperatively, patient was noted to have a long segment of penile and distal bulbar urethral stricture measuring 13cm with a fixed bulbar-membranous junction due to prior repair. Lingual and buccal grafts were harvested. The patient was discharged on post-operative day (POD) 1 with both an SPC and indwelling catheter (IDC) in situ. Upon review at POD 21, a peri-catheter ascending urethrogram revealed no leak and IDC was removed. On further follow up, Qmax improved to 19.1ml/s with good healing of operative wounds.

One-anterior urethroplasty is an effective and safe treatment for patients with severe penile urethral strictures following prior infections in the setting of prior urethral reconstruction.