✦ Urethral Stricture Treatment

EPA Urethroplasty (Excision & Primary Anastomosis)

Q: How long is the catheter in after EPA?

The catheter remains for 3–4 weeks to allow the anastomosis to heal before a voiding trial is performed. Your consultant will provide specific guidance based on your individual clinical situation and recovery.

Q: What is the stricture-free rate after EPA?

EPA achieves 90–95% success at 10 years for short bulbar strictures — the highest of any treatment modality. Your consultant will provide specific guidance based on your individual clinical situation and recovery.

Q: Can EPA be done for longer strictures?

EPA is ideally suited for strictures under 2 cm; longer strictures require graft urethroplasty with buccal mucosa. Your consultant will provide specific guidance based on your individual clinical situation and recovery.

Gold Standard Surgical Cure for Short Dense Bulbar Strictures

90–120 min PROCEDURE

2–3 Days HOSPITAL STAY

>90% SUCCESS RATE

3–4 Weeks RECOVERY

What is EPA Urethroplasty (Excision & Primary Anastomosis)?

EPA Urethroplasty excises the diseased stricture segment and directly anastomoses the healthy urethral ends under tension-free conditions. It is the gold-standard treatment for short (<2 cm) dense bulbar urethral strictures with significant spongiofibrosis, achieving cure rates above 90%. EPA provides durable long-term results superior to endoscopic treatments. The procedure is performed under general or spinal anaesthesia with a hospital stay of 2–3 Days. Success rates reach >90% in appropriately selected patients at experienced centres. Recovery takes approximately 3–4 Weeks, after which normal activities can be fully resumed.

Patients with short dense bulbar urethral strictures less than 2 cm, significant spongiofibrosis, or failed OIU. Patients must be adequately fit for anaesthesia and free from active systemic infection before proceeding.

How the Procedure Works

Patient Positioning

Under general or spinal anaesthesia, the patient is positioned in the exaggerated lithotomy position.

Urethral Exposure

The corpus spongiosum is opened longitudinally along the ventral aspect of the urethra through the full stricture length.

Stricture Excision

The diseased urethral segment and surrounding densely fibrosed corpus spongiosum are excised completely using sharp dissection.

Anastomosis

The spatulated ends of the healthy urethra are brought together without tension using interrupted 4-0 polyglactin sutures.

Wound Closure

The bulbospongiosus muscle is re-approximated over the anastomosis using absorbable sutures and the subcutaneous tissues closed in layers.

Outcomes

90–120 minDURATION

2–3 DaysHOSPITAL STAY

>90%SUCCESS RATE

3–4 WeeksFULL RECOVERY

Who Needs This Treatment?

→EPA urethroplasty achieves the highest cure rate of any treatment for short bulbar strictures.
→Limited to short strictures typically under 1–2 cm with dense spongiofibrosis.
→Preservation of the periurethral arterial blood supply is critical to anastomotic healing.
→Erectile dysfunction is a recognised risk and patients should be counselled pre-operatively.
→Post-operative urethral catheter for 2–3 weeks followed by a voiding trial.
→Durable long-term results with >90% patency at 10 years.

"EPA urethroplasty is my preferred treatment for short dense bulbar strictures. When excision and anastomosis are performed correctly, the results are excellent and essentially permanent."

— — Dr. Vipin Reddy, Consultant Urologist, Andrologist & Renal Transplant Surgeon

Common Questions

Frequently Asked

How long is the catheter in after EPA?+

What is the stricture-free rate after EPA?+

Can EPA be done for longer strictures?+

Not sure which treatment is right for you?

Book a consultation with Dr. Vipin Reddy and get a personalised treatment plan.

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