Unexpected course of urethroplasty in patient with penile prosthesis

Introduction: Urethral stricture disease is a complex and debilitating condition that significantly impairs urinary function and quality of life. Urethroplasty remains the gold-standard treatment, especially for complex, long-segment, or recurrent strictures. However, performing urethroplasty in patients with penile prostheses presents unique surgical challenges due to the associated anatomical and vascular considerations.

Case presentation: We report the case of a male patient with a history of penile prosthesis implantation nine years earlier who presented with a recurrent bulbar urethral stricture. The patient underwent excision and primary anastomosis (EPA) urethroplasty. Postoperatively, he developed significant urinary leakage at the anastomotic site, which was confirmed by pericatheter urethrogram, and urine culture grew extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli. The condition was managed conservatively with intravenous antibiotics and suprapubic catheter placement, resulting in resolution of the leakage and preservation of prosthesis function.

Discussion: This case highlights the interplay between urethral vascular compromise and the presence of a penile prosthesis, both of which can increase the risk of complications following urethroplasty. Infection, impaired healing, and altered anatomy contribute to the complexity of surgical management. Although the urethral stricture was amenable to EPA, the healing process was likely adversely affected by local infection and compromised blood supply.

Conclusion: Urethroplasty in patients with a penile prosthesis requires a tailored approach that accounts for altered anatomy and vascularity. In this case, the EPA was complicated by infection and urine leakage; however, conservative management resulted in successful healing, restoration of urinary flow, and preservation of prosthesis function. This case highlights the importance of careful surgical planning and flexible postoperative care.