Anastomotic and Augmented Anastomotic Urethroplasty

It has long been believed and accepted that complete excision of scar tissue and urethral stricture, followed by a primary end-to-end anastomosis, yields the best results. Santucci reported a long-term success rate of 95% for excision and anastomotic urethroplasty [1]. However, a closer look at the stricture etiology (traumatic vs non-traumatic) showed lower success rates in non-traumatic and short strictures. For non-traumatic strictures, the urethra on both sides of the resected segment may not be “normal” on a histological level, which likely leads to the higher failure rate. The success rate of excision and primary anastomotic (EPA) urethroplasty in non-traumatic strictures is as low as 66% in some series [2]. This is lower than the general accepted success rate of substitution urethroplasty – even for longer strictures – which is around 85%.