Urethral stricture following transurethral resection of the prostate (TUR-P) is a challenging complication, particularly when located in the proximal bulbar urethra near the external sphincter. The primary concern in managing these strictures is the preservation of urinary continence. We present the case of a 75-year-old male with a history of Diabetes Mellitus and a prior TUR-P in 2018. Following his initial surgery, he developed a stricture located 2 cm distal to the verumontanum. Despite undergoing multiple Amplatz and subsequent urethral dilatations between 2018 and 2025, the stricture recurred, necessitating a more definitive surgical solution. This video demonstrates the Continence-Preserving Ventral Urethroplasty technique as an effective treatment for post-prostatectomy proximal strictures.

The management strategy focused on achieving a patent lumen while safeguarding the distal sphincter mechanism: Pre-operative Assessment: A retrograde urethrography (RUG) in 2025 confirmed a recurrent stricture in the bulbar urethra. Clinical History: The patient's reliance on repeated dilatations for 7 years highlighted the failure of conservative management. Surgical Technique: A ventral onlay approach was utilized. By approaching the urethra ventrally, the surgical team aimed to avoid extensive dissection around the dorsal urethral complex and the external sphincter, thereby minimizing the risk of postoperative stress urinary incontinence (SUI). Patient Selection: Given his age and diabetic status, a minimally invasive yet durable reconstructive approach was prioritized to ensure rapid recovery and long-term success.

The ventral urethroplasty procedure was completed successfully. Anatomical Success: Intraoperative findings confirmed a dense stricture segment in the proximal bulbar urethra which was widened using the onlay technique. Voiding Recovery: Post-operative follow-up showed excellent urinary flow rates compared to his previous post-dilatation states. Functional Outcomes: Most importantly, the urinary continence was fully preserved. The patient reported no episodes of leakage, confirming that the ventral approach effectively protected the remaining sphincter function even in a post-TURP anatomy. Stability: At the latest follow-up, the patient remained symptom-free without the need for further instrumentation.

Continence-preserving ventral urethroplasty is a highly effective salvage option for patients with recurrent proximal bulbar strictures following TUR-P. In older patients with comorbidities like Diabetes Mellitus, the priority is to provide a durable repair that does not compromise quality of life through incontinence. This technique demonstrates that by meticulously choosing the surgical plane and avoiding dorsal sphincter dissection, surgeons can achieve high anatomical success rates while maintaining the patient’s continence, even after previous endourological failures.

Lumen, N., et al. (2011). "Strictures after radiotherapy or transurethral resection of the prostate: a challenge for the reconstructive urologist." World Journal of Urology.
Horiguchi, A. (2017). "Urethral reconstruction for strictures distal to the external sphincter following prostate surgery." Investigative and Clinical Urology.
Mundy, A. R., & Andrich, D. E. (2011). "Urethral strictures." BJU International.

Continence 19S (2026) 102736
DOI: 10.1016/j.cont.2026.102736