The case for excision and primary anastomotic urethroplasty for bulbar urethral stricture

With an estimated prevalence of 296 to 627 per 100.000 men, male urethral stricture disease imposes a significant burden on the health care system (1, 2). Urethroplasty has demonstrated durable, high success rates in the management of a wide spectrum of stricture disease, far exceeding that of the more commonly performed but less successful direct vision internal urethrotomy (DVIU) (1, 3-5). While procedure selection depends on stricture characteristics (length, location, and etiology), the high success rate of excision and primary anastomotic (EPA) urethroplasty makes it the procedure of choice for most strictures of the bulbar urethra (6). However, concerns regarding the effect of urethral transection on male sexual health has led some centers to advocate for substitution urethroplasty (7), likely contributing to an increase in these procedures (8). Our objective is to review the literature supporting EPA urethroplasty in strictures of the bulbar urethra.