Non-Transecting Anastomotic Urethroplasty Versus Excision and Primary Anastomosis for Non-Traumatic Posterior Urethral Stenosis: A Preliminary Feasibility Study

Sadayoshi Suzuki; Akio Horiguchi; Takahiro Minami; Kazuki Takekawa; Yoshiyuki Furukawa; Yuhei Segawa; Kenichiro Ojima; Masayuki Shinchi; Daisuke Watanabe; Keiichi Ito

doi:10.1111/iju.70073

Non-Transecting Anastomotic Urethroplasty Versus Excision and Primary Anastomosis for Non-Traumatic Posterior Urethral Stenosis: A Preliminary Feasibility Study

Int J Urol. 2025 Apr 15. doi: 10.1111/iju.70073. Online ahead of print.

Authors

Affiliations

¹ Department of Urology, National Defense Medical College, Saitama, Japan.
² Division of Reconstruction, Center for Trauma, Burn and Tactical Medicine, National Defense Medical College Hospital, Saitama, Japan.
³ Department of Molecular and Cellular Therapeutics, Juntendo University Graduate School of Medicine, Tokorozawa, Saitama, Japan.
⁴ Department of Urology, Koto Hospital, Tokyo, Japan.

PMID: 40231484
DOI: 10.1111/iju.70073

Abstract

Objectives: To compare the feasibility and outcomes of non-transecting anastomotic urethroplasty (NTAU) with excision and primary anastomosis (EPA) in the management of non-traumatic posterior urethral stenosis (PUS).

Methods: We retrospectively reviewed 30 male patients who underwent anastomotic urethroplasty for non-traumatic PUS between October 2013 and July 2024. EPA was performed in 15, and NTAU in 15. Surgical success was defined as the absence of recurrent stenosis on cystourethroscopy without additional intervention. Patient-reported outcomes, including lower urinary tract symptoms (LUTS), continence status, and quality of life measures, were assessed using validated questionnaires.

Results: The surgical success rate was 100% for NTAU and 86.7% for EPA (p = 0.14). Operative time was significantly shorter in the NTAU group (158 vs. 199 min, p = 0.04). The proportion of pad-free patients was significantly higher in the NTAU group (p = 0.01). Among 14 patients with preserved bladder neck function, 8 (80.0%) in the NTAU group achieved pad-free status, whereas none in the EPA group did (p = 0.006). Both groups showed significant improvements in LUTS-specific quality of life (p = 0.03 for NTAU, p = 0.0006 for EPA) with no significant differences between groups (p = 0.78). Changes in Sexual Health Inventory for Men (SHIM) scores were comparable between groups (p = 0.41).

Conclusions: NTAU demonstrated comparable surgical success rates to EPA with shorter operative times and better continence outcomes, particularly in patients with preserved bladder neck function. These preliminary results suggest that NTAU is a feasible alternative to EPA for non-traumatic PUS, though longer follow-up and larger studies are needed to confirm these findings.

Keywords: excision and primary anastomosis; non‐transecting anastomotic urethroplasty; patient‐reported outcomes; posterior urethral stenosis; urinary continence.