Excision and primary anastomosis for anterior urethral stricture.

Excision with spatulated primary anastomosis (EPA) is an excellent reconstructive option for short bulbar urethral strictures with success rates between 90 and 95% in appropriately selected patients. Patient selection requires a careful history, physical examination, and radiographic staging. Failure with this reliable method is caused by inadequate excision of urethral stricture and incomplete mobilization of the urethra with excessive anastomotic tension. Complications that include wound and urinary tract infections, chordee, and erectile dysfunction, are uncommon. EPA warrants strong consideration as a first line treatment due to its excellent and durable long-term results.