Panurethral strictures represent one of the most complex entities in reconstructive urology, often requiring multiple surgical interventions over several decades. We present the case of a 51-year-old male whose journey began at age 11, following catheterization during an appendectomy. Over the next 40 years, the patient underwent numerous urethral dilatations, internal urethrotomies, and a TOT (Transobturator Tape) surgery—the latter of which was later removed due to chronic infection. Upon presentation to our clinic, the patient was dependent on intermittent self-dilatation (ISD) to maintain minimal voiding. This video highlights the surgical management of a panurethral stricture complicated by scarring from previous mesh-related infections.

A systematic approach was necessary for this multi-focal and extensive pathology: Clinical History: A 40-year chronicity of stricture disease with a history of failed endourological procedures and infected mesh excision. Pre-operative Assessment: Evaluation confirmed a panurethral stricture involving the bulbar and penile segments. The surgical environment was significantly compromised by previous internal urethrotomies (most recently in October 2025) and secondary fibrosis from the infected TOT site. Surgical Strategy: Given the extensive nature of the stricture, a panurethral reconstruction was planned. The objective was to replace or augment the entire narrowed lumen using a durable graft (such as Buccal Mucosa Graft - BMG) or a multi-stage approach, ensuring the removal of residual fibrotic tissue from the previous "otolog/mesh" complications.

The extensive reconstruction was performed successfully, aiming for a permanent solution to a lifelong problem.Intraoperative Findings: Significant spongiofibrosis was observed throughout the panurethral segment, exacerbated by the previous mesh-related inflammatory response.Post-operative Outcome: The patient successfully transitioned away from the 40-year cycle of intermittent self-dilatation.Functional Gains: Follow-up evaluations showed a stable urethral caliber and a significantly improved peak flow rate Qmax, providing the patient with his best voiding quality since childhood.Quality of Life: The resolution of chronic obstructive symptoms and the cessation of painful self-instrumentation marked a transformative improvement in the patient's daily life.

The management of panurethral strictures in patients with long-term "failed-urethra" syndrome requires more than just simple dilatation; it demands a definitive reconstructive approach. This case demonstrates that even after four decades of recurrent stricture disease and complex mesh-related complications, a comprehensive urethroplasty can provide a durable cure. Clinicians should prioritize early definitive reconstruction over repetitive internal urethrotomies to avoid the progressive fibrosis seen in this lifelong clinical journey.

Gelman, J., et al. (2011). "One-stage reconstruction of panurethral strictures at a single institution." The Journal of Urology.
Kulkarni, S., et al. (2009). "One-stage reconstruction of panurethral stricture by combined dorsal onlay buccal mucosa graft and skin flap." BJU International.
Horiguchi, A., et al. (2018). "Long-term outcomes of urethroplasty for panurethral strictures." International Journal of Urology.