Urethral strictures remain a challenging condition in urology, often necessitating repeated interventions. Traditional treatments such as direct vision internal urethrotomy (DVIU) and open urethroplasty have limitations, including high recurrence rates and morbidity. Endourethroplasty is emerging as a promising minimally invasive alternative, aiming to combine the advantages of endoscopic intervention with improved graft-based tissue integration. This study evaluates the efficacy and safety of a novel two-step endourethroplasty technique in patients with urethral strictures.

Study Design A prospective study was conducted involving 20 patients with urethral strictures who underwent endourethroplasty. The procedure was performed in a two-step manner. Surgical Technique Step 1: Direct vision internal urethrotomy (DVIU) was performed using a 24Fr urethrotome. The length and location of the stricture were measured from the bladder neck. 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 site of the stricture. The catheter was secured, and the graft was left in place for four weeks to allow epithelialization. Postoperatively, the catheter was removed at four weeks, 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.

Preliminary data indicate a 100% success rate in maintaining urethral patency. The average peak flow rate increased by 20 mL/s. Complications were minimal, with most patients experiencing minor adverse events. Quality of life scores improved significantly post-procedure (p < 0.05).

Endourethroplasty demonstrates promise as a safe and effective option for managing urethral strictures. The technique successfully maintains urethral patency, improves urinary flow, and enhances patient quality of life. Further research with larger patient cohorts is warranted to validate these findings.