Twenty-five Years of Panurethral Stricture Repair Using the Kulkarni Technique

Area of Science:

• Reconstructive Urology
• Urethral Stricture Disease Management
• Tissue Grafting Techniques

Background:

• Panurethral stricture disease presents significant challenges in reconstructive urology.
• Surgical management has evolved from staged procedures to single-stage panurethroplasty over 25 years.
• Dorsal buccal mucosal graft urethroplasty (BMGU) with one-sided dissection offers a reproducible strategy.

Purpose of the Study:

• To review the evolution and current state of surgical management for panurethral stricture disease.
• To highlight advancements in reconstructive urology for urethral strictures.
• To assess the efficacy and limitations of various tissue graft techniques.

Main Methods:

• Review of surgical techniques including staged skin substitution, single-stage panurethroplasty, dorsal buccal mucosal graft urethroplasty, and spiral preputial grafts.
• Analysis of long-term success rates from large series and intermediate-term outcomes from contemporary multicenter data.
• Emphasis on patient selection criteria for different reconstructive approaches.

Main Results:

• Dorsal buccal mucosal graft urethroplasty demonstrates durable long-term success rates of 80-85%.
• Spiral preputial grafts allow for continuous long-segment reconstruction in selected patients.
• Contemporary multicenter data show acceptable intermediate-term outcomes with careful patient selection.

Conclusions:

• Single-stage panurethroplasty using tissue grafts is now a viable option for long urethral strictures.
• Modern reconstructive techniques, particularly BMGU, provide good long-term results when performed in specialized centers.
• Continued innovation and careful patient selection are essential for optimizing outcomes in urethral stricture repair.