Substitution urethroplasty for posterior urethral stenosis
Alain Kaldany1, Benjamin Cedars1, Dmitriy Nikolavsky1
1Department of Urology, SUNY Upstate Medical University, Syracuse, NY, USA.
Translational Andrology and Urology
|January 12, 2026
Summary
Posterior urethral stenosis can be treated with substitution urethroplasty using buccal mucosa graft (BMG). This technique offers versatility and favorable outcomes for urethral reconstruction.
Area of Science:
- Urology
- Surgical Reconstruction
Background:
- Posterior urethral stenosis commonly follows trauma, prostate treatments, or pelvic radiation.
- Reconstruction options include excisional urethroplasty or substitution urethroplasty with buccal mucosa graft (BMG).
Purpose of the Study:
- To provide a stepwise description of a technique for posterior substitution urethroplasty.
- To review institutional outcomes and literature supporting this reconstructive approach.
Main Methods:
- Detailed description of a posterior substitution urethroplasty technique.
- Key maneuvers include urethral mobilization, graft fixation (laparoscopic suturing, fibrin sealant, barbed suture), and specialized instrumentation (RaViNi speculum).
Main Results:
- Retrospective studies report success rates for posterior substitution urethroplasty between 63% and 89%.
- Rates of new-onset urinary incontinence range from 0% to 11%.
Conclusions:
- Substitution urethroplasty is a versatile technique for posterior urethral reconstruction.
- It offers favorable rates of new-onset stress urinary incontinence compared to excisional urethroplasty.
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