Single-stage augmentation urethroplasty for urethral strictures following peri-urethral abscess: Reconstructive challenges and long-term outcomes

Background: Urethral strictures following peri-urethral abscess (PUA) represent a distinct and complex reconstructive challenge due to severe infective tissue injury, dense spongiofibrosis, compromised vascularity, and frequent long-segment involvement. This study evaluated the techniques and outcomes of augmentation urethroplasty for urethral strictures following periurethral abscess. Materials and Methods: This retrospective study analyzed a prospectively maintained database of patients undergoing urethral reconstruction between January 2016 and December 2024. Patients with urethral strictures following PUA who underwent single-stage augmentation urethroplasty with a minimum follow-up of 12 months were included. Demographic data, abscess characteristics, stricture anatomy, reconstructive techniques, perioperative outcomes, and long-term functional results were evaluated. Success was defined as satisfactory voiding without the need for any secondary intervention. Results: Forty-seven patients were analyzed. Diabetes mellitus was present in 32 (68.1%) patients. The mean stricture length was 9 ± 4 cm, with pan-urethral involvement in 25.5%, reflecting complex strictures Buccal mucosal graft augmentation was the primary reconstructive approach, while penile skin flaps or combined graft-and-flap techniques were required in 34% due to compromised graft bed quality. Single-stage augmentation urethroplasty achieved success in 33 patients (70.3%) at a mean follow-up of 4.4 ± 1.9 years. Secondary intervention was required in 14 patients (29.7%), most commonly endoscopic management; redo-urethroplasty or perineal urethrostomy was necessary in five patients. Conclusions: Urethral strictures following PUA constitute a high-risk reconstructive subgroup. Following adequate sepsis control and urethral rest, single-stage augmentation urethroplasty can achieve acceptable long-term outcomes, although patients should be counseled regarding increased technical complexity and a higher likelihood of secondary intervention.