[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"doc-seo-456699-105":3,"detail-sidebar-cat-0-en-105":81,"doc-detail-456699-en":130},{"code":4,"msg":5,"data":6},0,"ok",{"site_id":7,"language":8,"slug":9,"title":10,"keywords":11,"description":12,"schema_data":13,"social_meta":74,"head_meta":76,"extra_data":78,"updated_unix":80},105,"en","substitution-urethroplasty-for-posterior-urethral-stenosis-surgical-technique","Substitution urethroplasty for posterior urethral stenosis - Surgical Technique","","Posterior urethral stenosis commonly follows traumatic urethral injury, procedures for benign prostatic hyperplasia or prostate cancer, and pelvic radiation. Perineal reconstruction can be performed with excisional urethroplasty and primary anastomosis or with substitution urethroplasty using buccal mucosa grafts (BMG). This article describes a stepwise, comprehensive technique for posterior substitution urethroplasty and provides perioperative recommendations to avoid common pitfalls, including key maneuvers for urethral mobilization and graft fixation, plus exposure methods using a lighted speculum. Retrospective evidence reports success rates of 63–89% and de novo incontinence of 0–11%.",{"@graph":14,"@context":73},[15,34,56],{"@type":16,"itemListElement":17},"BreadcrumbList",[18,23,27,31],{"item":19,"name":20,"@type":21,"position":22},"https://docshare.wps.com","Home","ListItem",1,{"item":24,"name":25,"@type":21,"position":26},"https://docshare.wps.com/document/","Document",2,{"item":28,"name":29,"@type":21,"position":30},"https://docshare.wps.com/document/healthcare/","Healthcare",3,{"item":32,"name":10,"@type":21,"position":33},"https://docshare.wps.com/document/substitution-urethroplasty-for-posterior-urethral-stenosis-surgical-technique/456699/",4,{"url":32,"name":10,"@type":35,"image":36,"author":41,"headline":10,"publisher":44,"fileFormat":47,"inLanguage":8,"description":12,"dateModified":48,"datePublished":49,"encodingFormat":47,"isAccessibleForFree":50,"interactionStatistic":51},"DigitalDocument",{"url":37,"@type":38,"width":39,"height":40},"https://docshare.wps.com/thumbnails/substitution-urethroplasty-for-posterior-urethral-stenosis-surgical-technique/456699.png","ImageObject",300,407,{"name":42,"@type":43},"Logic","Person",{"url":19,"name":45,"@type":46},"DocShare","Organization","application/pdf","2026-11-02","2026-09-30",true,{"@type":52,"interactionType":53,"userInteractionCount":55},"InteractionCounter",{"@type":54},"ViewAction",9,{"@type":57,"mainEntity":58},"FAQPage",[59,65,69],{"name":60,"@type":61,"acceptedAnswer":62},"What conditions most commonly lead to posterior urethral stenosis?","Question",{"text":63,"@type":64},"Posterior urethral stenosis commonly occurs after traumatic urethral injury, iatrogenic injury during treatment for benign prostatic hyperplasia or prostate cancer, and pelvic radiation.","Answer",{"name":66,"@type":61,"acceptedAnswer":67},"How does substitution urethroplasty differ from excisional urethroplasty for posterior stenosis?",{"text":68,"@type":64},"Perineal reconstruction can be done via excisional urethroplasty with primary anastomosis or via substitution urethroplasty using buccal mucosa grafts (BMG). The article emphasizes substitution urethroplasty when feasible due to favorable outcomes.",{"name":70,"@type":61,"acceptedAnswer":71},"What perioperative techniques and tools does the article highlight?",{"text":72,"@type":64},"Key maneuvers include unilateral urethral mobilization and graft fixation using laparoscopic suturing devices, fibrin sealant, or barbed-suture machinery. The article also describes using the RaViNi lighted urethral speculum to enhance urethral exposure.","https://schema.org",{"og:url":32,"og:type":75,"og:title":10,"og:site_name":45,"og:description":12},"article",{"robots":77,"canonical":32},"index,follow",{"doc_id":79,"site_id":7},456699,1790964306,{"code":4,"msg":82,"data":83},"success",[84,88,92,96,101,106,110,115,119,122,126],{"id":22,"doc_module":4,"doc_module_name":25,"category_name":85,"show_sort_weight":86,"slug":87},"Story & Novel",90,"story-novel",{"id":26,"doc_module":4,"doc_module_name":25,"category_name":89,"show_sort_weight":90,"slug":91},"Literature",80,"literature",{"id":33,"doc_module":4,"doc_module_name":25,"category_name":93,"show_sort_weight":94,"slug":95},"Exam",70,"exam",{"id":97,"doc_module":4,"doc_module_name":25,"category_name":98,"show_sort_weight":99,"slug":100},5,"Comic",60,"comic",{"id":102,"doc_module":4,"doc_module_name":25,"category_name":103,"show_sort_weight":104,"slug":105},6,"Technology",50,"technology",{"id":107,"doc_module":4,"doc_module_name":25,"category_name":29,"show_sort_weight":108,"slug":109},7,40,"healthcare",{"id":111,"doc_module":4,"doc_module_name":25,"category_name":112,"show_sort_weight":113,"slug":114},8,"Research & Report",30,"research-report",{"id":55,"doc_module":4,"doc_module_name":25,"category_name":116,"show_sort_weight":117,"slug":118},"Religion & Spirituality",20,"religion-spirituality",{"id":117,"doc_module":4,"doc_module_name":25,"category_name":120,"show_sort_weight":117,"slug":121},"World Cup","world-cup",{"id":123,"doc_module":4,"doc_module_name":25,"category_name":124,"show_sort_weight":123,"slug":125},10,"Lifestyle","lifestyle",{"id":127,"doc_module":4,"doc_module_name":25,"category_name":128,"show_sort_weight":97,"slug":129},19,"General","general",{"code":4,"msg":82,"data":131},{"doc_id":79,"user_id":132,"nickname":42,"user_avatar":133,"doc_module":4,"category_id":107,"category_name":29,"doc_title":10,"doc_description":12,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":55,"is_deleted":4,"is_public":22,"is_downloadable":22,"audit_status":22,"page_count":139,"language":140,"language_code":8,"site_id":7,"html_lang":8,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":12,"update_tm":144,"read_time":145,"preview_page_count":4},1099513958762,"https://ap-avatar.wpscdn.com/avatar/1000023916a998db790?x-image-process=image/resize,m_fixed,w_180,h_180&k=1784791008015729253","Surgical Technique  \nSubstitution urethroplasty for posterior urethral stenosis  \nAlain Kaldany, Benjamin Cedars, Dmitriy Nikolavsky  \nDepartment of Urology, SUNY Upstate Medical University, Syracuse, NY, USA  \nContributions: (I) Conception and design: D Nikolavsky; (II) Administrative support: None; (III) Provision of study materials or patients: None; (IV) Collection and assembly of data: A Kaldany; (V) Data analysis and interpretation: None; (VI) Manuscript writing: All authors; (VII) Final approval of  \nmanuscript: All authors.  \nCorrespondence to: Dmitriy Nikolavsky, MD. Department of Urology, SUNY Upstate Medical University, 550 Harrison Street, Syracuse, NY 13202, [USA. Email: nikolavd@upstate.edu](USA. Email: nikolavd@upstate.edu).  \nAbstract: Posterior urethral stenosis occurs commonly following traumatic urethral injury, treatment for prostatomegaly or prostate cancer, and pelvic radiation. Perineal reconstruction for posterior urethral stenosis can be performed via excisional urethroplasty with primary anastomosis, or via substitution urethroplasty with the use of buccal mucosa graft (BMG) . This article provides a stepwise description and comprehensive review of our technique for posterior substitution urethroplasty. Helpful tips and recommendations regarding common pitfalls encountered perioperatively are also presented. Key maneuvers described include unilateral urethral mobilization, graft fixation using laparoscopic suturing devices, fibrin sealant, or a barbed-suture sewing machine, as well as the use of the RaViNi lighted urethral speculum to enhance urethral exposure. In addition to describing our technique and institutional outcomes, a brief and focused review of the literature is presented to support the utility of substitution urethroplasty in posterior urethral reconstruction. While there is a dearth of prospective data, retrospective studies from single-center and multi-institutional data report success rates for posterior substitution urethroplasty between 63% and 89%, with rates of de novo urinary incontinence ranging from 0% to 11% . Overall, substitution urethroplasty offers key advantages such as versatility and favorable rates of de novo stress urinary incontinence, making it  \npreferable to excisional urethroplasty for posterior urethral reconstruction, when feasible.  \nKeywords: Posterior urethroplasty; substitution urethroplasty; buccal mucosa graft (BMG); posterior urethral  \nreconstruction  \nSubmitted Aug 14, 2025. Accepted for publication Dec 03, 2025. Published online Dec 26, 2025.  \ndoi: 10.21037/tau-2025-566  \nView this article at: [https://dx.doi.org/10.21037/tau-2025-566](https://dx.doi.org/10.21037/tau-2025-566)  \nIntroduction  \nPosterior urethral stenosis is characterized by luminal narrowing of the urethra spanning the bladder neck, prostatic urethra, and membranous urethra. As opposed to anterior urethral narrowing, which is termed “stricture” and characterized by spongiofibrosis, posterior urethral narrowing is more accurately deemed “stenosis” due to the lack of investing corpus spongiosum surrounding these segments of the urethra (1) . Anterior urethral stricture is significantly more common than posterior urethral stenosis, representing 92% of all urethral stricture, and as such posterior urethral stenosis is comparatively less well-studied (2) .  \nPosterior urethral stenosis most commonly occurs following traumatic urethral injury or iatrogenically after treatment for benign prostatic hyperplasia (BPH) or prostate cancer. Outlet procedures for BPH, including transurethral resection, holmium laser enucleation, photoselective vaporization, and other modalities, are estimated to lead to posterior urethral stenosis in 0.3–9.7% of patients (3) . Treatment for prostate cancer leads to posterior urethral stenosis in 1–5% of patients, with rates varying by modality between patients who undergo radical prostatectomy, external beam radiation therapy, brachytherapy, or ablative techniques","cbCaic2NIfrQAHYX","https://ap.wps.com/l/cbCaic2NIfrQAHYX","pdf",4817975,13,"English","# Introduction\n## Definition and epidemiology of posterior urethral stenosis\n## Etiology by traumatic injury and iatrogenic causes\n## Treatment principles and rationale for substitution urethroplasty\n# Preoperative preparations and requirements\n## Surgical highlights","[{\"question\":\"What conditions most commonly lead to posterior urethral stenosis?\",\"answer\":\"Posterior urethral stenosis commonly occurs after traumatic urethral injury, iatrogenic injury during treatment for benign prostatic hyperplasia or prostate cancer, and pelvic radiation.\"},{\"question\":\"How does substitution urethroplasty differ from excisional urethroplasty for posterior stenosis?\",\"answer\":\"Perineal reconstruction can be done via excisional urethroplasty with primary anastomosis or via substitution urethroplasty using buccal mucosa grafts (BMG). The article emphasizes substitution urethroplasty when feasible due to favorable outcomes.\"},{\"question\":\"What perioperative techniques and tools does the article highlight?\",\"answer\":\"Key maneuvers include unilateral urethral mobilization and graft fixation using laparoscopic suturing devices, fibrin sealant, or barbed-suture machinery. The article also describes using the RaViNi lighted urethral speculum to enhance urethral exposure.\"}]","Substitution urethroplasty for posterior urethral stenosis - Surgical Technique | PDF",1790746744,33]