Our department’s experience with the reconstruction of urethral panstricture using the Kulkarni method

Overview

Introduction: Urethroplasty is one of the technically demanding procedures. The treatment of complex urethral lesions affecting multiple parts of the urethra at the same time is a challenge for urologists. Finding the optimal therapeutic method can be of fundamental importance. Kulkarni’s technique of one-way dorsolateral onlay substitution urethroplasty using oral mucosa has been the preferred method for the treatment of long and complex urethral strictures in the world in recent years. The aim of this communication and video presentation of the surgical procedure is to present the experience of our department with two patients who underwent successful operations using this technique. Materials and methods: We present retrospectively two case reports of male patients with urethral panstricture operated on in 2024 at our institution. The first was a 65-year-old man referred from the urology department for a 13 cm post-instrumentation stricture, the second was a 71-year-old man with a history of repeated infections and endoscopic instrumentation with urethral involvement of 14 cm. In both cases, a complete preoperative imaging and endoscopic examination was performed, confirming the significant extent of urethral involvement, in the first case from the meatus to the bulbar urethra. The operation was performed via a perineal approach in a single-stage procedure using buccal mucosa. Results: Operative time was an average of 210 minutes, catheterization for a total of 21 days. The postoperative course was uncomplicated in both patients. During the 12-month follow-up, a significant subjective improvement in urine flow was achieved, according to uroflowmetry after 6 months from the operation, Q_max was 18.6 mL/s and 16.2 mL/s, respectively. Control urethrography didn´t record significant restriction in either patients. Conclusion: Both patients operated on at our institution have satisfactory postoperative results confirmed by urethrography, endoscopy, and functional examination on uroflowmetry. The Kulkarni method represents an effective and safe single-stage surgical modality applicable to the treatment of urethral panstrictures. Although the follow-up period of our patients is relatively short, the results of case reports so far show that with careful indication and surgical technique, this method can achieve very good functional results with a low incidence of complications. 

Keywords:

urethral stricture – buccal mucosa – Kulkarni uretroplasty