Endoscopic dual-approach laser urethrotomy as a last-option for complex urethral stricture: A case report

Anterior urethral stricture is a common complication following pelvic trauma, with posterior urethral involvement observed in 10-25 % of pelvic fractures. Traditional management includes end-to-end anastomosis or urethroplasty, but these approaches may not always be suitable in cases of patient refusal or contraindication. Minimally invasive alternatives, such as endoscopic urethrotomy, are increasingly being considered.

We present the case of a 30-year-old male with a complex anterior urethral stricture following pelvic trauma. Due to the patient's reluctance toward open end-to-end anastomosis, we performed a dual-route endoscopic laser urethrotomy. This hybrid approach, combining transurethral and transvesical Holmium laser access, was performed under spinal anesthesia. The procedure allowed for guidewire passage and urethrotomy enlargement within a 4-minute duration.

In patients unwilling or unfit for open reconstructive surgery, endoscopic laser urethrotomy can serve as a viable alternative. The hybrid technique provides enhanced access and visualization, offering a minimally invasive solution for complex strictures. Early intervention, in this case within two weeks, helped prevent significant tissue scarring, reducing the risk of recurrence. Additionally, the implementation of a clean intermittent self-catheterization (CISC) protocol postoperatively further aids in preventing stricture formation and maintaining urethral patency.

This case highlights the success of a dual-route endoscopic laser urethrotomy as an effective treatment for anterior urethral stricture, particularly in patients who refuse or are contraindicated for open surgery. While not a substitute for definitive surgical repair, this approach offers a promising, minimally invasive option with favorable short- and medium-term outcomes.