Post-traumatic urethral strictures, especially those resulting from high-impact pelvic fractures, often lead to complex, multi-segmental obliterative lesions. While augmented anastomotic urethroplasty is the gold standard for long-term success, recurrence remains a significant clinical challenge. Management of these recurrent cases traditionally involves repeated dilatations or complex redo-surgeries, which carry diminishing success rates. We present the case of a 27-year-old male with a complete bulbar urethral obliteration following a traffic accident, who was successfully treated with a Paclitaxel-coated balloon (Optilume®) after a failed urethroplasty.

The patient's clinical journey was characterized by: Initial Trauma: Pelvic trauma in March 2024, leading to initial catheterization and subsequent complete urinary retention (glob vesicale) in July 2024. Diagnostics: MR Urography and combined antegrade/retrograde urethroscopy confirmed a 2.5 cm complete obstruction of the bulbar urethra.Surgical History: In December 2024, the patient underwent Augmented Anastomotic Urethroplasty. During the postoperative follow-up (February–July 2025), recurrent stricture was observed, and traditional Amplantz dilatation failed to provide symptomatic relief. Intervention: In December 2025, a minimally invasive salvage therapy was performed using the Optilume® Urethral Drug-Coated Balloon (30 Fr, 5 cm). This device combines mechanical dilatation with the localized delivery of Paclitaxel to inhibit fibroblast proliferation and reduce fibrosis.

The Optilume® procedure was performed with a brief catheterization period of only 3 days. 3-Month Follow-up (March 2026): The patient reported a complete resolution of voiding symptoms. Uroflowmetry Parameters: Peak Flow Rate (Qmax): 20 mL/s (Significant improvement from previous low flow states).Voided Volume: 350 mL. Post-Void Residual (PVR): Minimal at 20 mL. The patient maintains stable voiding function without the need for further dilatations.

This case highlights the efficacy of Paclitaxel-coated balloon dilatation as a viable salvage therapy for recurrent bulbar urethral strictures following failed urethroplasty. In complex traumatic cases where repeat open surgery may be technically demanding or undesirable for the patient, drug-coated balloons offer a promising, minimally invasive alternative. By combining mechanical expansion with anti-proliferative therapy, this approach significantly improves urinary flow parameters and prevents early restenosis.

Elliott, S. P., et al. (2022). "One-year results for the ROBUST III randomized controlled trial evaluating the Optilume drug-coated balloon for anterior urethral strictures." The Journal of Urology.
Mann, R. A., et al. (2021). "Drug-coated balloons for urethral stricture disease: A review of the current evidence." International Urology and Nephrology.
Virasoro, R., et al. (2020). "Drug-coated balloon for urethral stricture: 2-year results from the ROBUST I study." Urology.