Minimally Invasive Treatments for Posterior Urethral Stenosis

The objective of this study was to summarize and review literature on treatment methods for stenoses of the posterior urethra. Stenosis of the posterior urethra, particularly of a bladder neck stenosis (BNS) or vesicourethral anastomotic stenosis (VUAS), presents significant clinical challenges, in part owing to the heterogeneity of the patient population and additionally secondary to morbidity of historic definitive treatments. Traditionally, this disease process has been preferentially managed with endoscopic interventions in the form of direct vision internal urethrotomy or dilation, with or without injectables, with variable success rates ranging from 40.0% to 72.0%; however, 90.0% of patients require repeat intervention within the first 2 years. Definitive treatments were often more challenging, requiring joint abdominoperineal approaches, and thus less utilized outside of academic centers with reconstructive urologists. Recent advancements in the endoscopic management of posterior urethral stenosis are synthesized in this review, specifically in populations at increased risk, including those with radiation therapy, transurethral prostate resections, or radical prostatectomy. Herein, a literature review of publications from 2014 to 2024 highlights key endoscopic techniques such as drug-coated balloon dilation and transurethral mucosal realignment aimed at treating BNS and VUAS. These novel techniques demonstrate short-term success rates approaching 85.0% to 90.0%, which represents a significant improvement in success compared with traditional endoscopic therapies. Overall, the current review emphasizes the evolution of minimally invasive treatment options for posterior urethral stenosis, focusing specifically on BNS and VUAS, demonstrating the evolution of the scope of minimally invasive techniques and improved patient outcomes.