Establishing the role of single-stage preputial spiral graft urethroplasty for panurethral stricture

Marco Bandini; Pankaj Joshi; Sandeep Bafna; Christian Yepes; Ahmed Alrefaey; Mattia Longoni; Francesco Montorsi; Sanjay Kulkarni

doi:10.1111/bju.16796

Establishing the role of single-stage preputial spiral graft urethroplasty for panurethral stricture

BJU Int. 2025 May 24. doi: 10.1111/bju.16796. Online ahead of print.

Authors

Marco Bandini^#¹, Pankaj Joshi^#², Sandeep Bafna³, Christian Yepes⁴, Ahmed Alrefaey⁵, Mattia Longoni¹, Francesco Montorsi¹, Sanjay Kulkarni²

Affiliations

¹ Division of Experimental Oncology/Unit of Urology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy.
² Department of Urology, Kulkarni Reconstructive Urology Center, Pune, India.
³ Department of Genitourinary Surgery, Apollo Main Hospital, Chennai, Tamil Nadu, India.
⁴ Center for Genital Reconstructive Surgery, Cali, Colombia.
⁵ Department of Urology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt.

^# Contributed equally.

PMID: 40411315
DOI: 10.1111/bju.16796

Abstract

Objective: To assess whether single-stage preputial spiral graft urethroplasty (PSGU) minimises panurethral stricture (PUS) recurrence, which often result from traditional multiple grafting for anterior urethral strictures exceeding 10 cm.

Patients and methods: We prospectively collected 114 patients with PUS treated with single-stage PSGU across five centres in India, Colombia, Egypt, and Italy since May 2021. Preoperative assessment included physical examination, medical history, uroflowmetry, International Prostate Symptom Score (IPSS), five-item International Index of Erectile Function (IIEF-5), and urethrography. Intraoperative urethroscopy assessed stricture length and severity. Follow-up included uroflowmetry and patient-reported outcomes. Treatment success was defined as a maximum urinary flow rate (Q_max) >10 mL/s without symptoms. Outcomes were compared between teaching and fellows' institutions.

Results: The median stricture length was 16 cm, with instrumentation as the most frequent aetiology (64.0%). The median (interquartile range [IQR]) operative time was 134 (123-142) min. Postoperative complications rate was 23.0%, mostly Clavien-Dindo Grade I. At a median (IQR) follow-up of 16 (7-24) months, the median Q_max significantly increased from 4.5 preoperatively to 24 mL/s postoperatively (P < 0.001), while the median IPSS decreased by 24.3 points (P < 0.001) and the median IIEF-5 score remained stable. Stricture recurrence occurred in 11 (9.6%) patients. No significant differences in patency/complications were found between teaching and fellows' institutions. Key PSGU limitations are intact prepuce and absence of active lichen sclerosus.

Conclusions: A single-stage PSGU effectively manages PUS, showing comparable outcomes across institutions with varying experience levels. This technique is ready for broader adoption in clinical practice, pending further studies to confirm its long-term efficacy.

Keywords: panurethral; single‐stage; spiral preputial graft; urethral stricture; urethroplasty.