Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Article
  • Published:

Synchronous management of urethral stricture disease and penile prosthesis implantation: a case series

International Journal of Impotence Research volume 37, pages 926–931 (2025)Cite this article

Subjects

Abstract

There is currently limited data to describe managing a urethral stricture identified while attempting penile prosthesis placement. This study reports our management of urethral strictures during penile prosthesis placement and proposes a guideline for this event. A retrospective analysis was performed on patients who underwent penile prosthesis implantation and had incidentally found urethral stricture disease from 2009 to 2023. Cases that proceeded to the placement of penile implant were classified as “completed,” while cases that could not proceed were classified as “aborted.” Successful management was defined as the absence of complications requiring explantation within 90 days of the procedure. Twenty-four cases were identified. Of these twenty-four patients, eighteen had completed procedures, while six had their procedures aborted. Within 90 days after the procedure, one patient presented with urinary retention. No patients had penile prosthesis infections within 90 days. Of the six “aborted” patients, five had strictures greater than 2 cm in length with urethral lumens between 8–10F. One patient had an obliterated urethra; three patients underwent urethroplasty; one patient underwent urethral dilation and suprapubic tube placement; and two patients underwent a direct vision internal urethrotomy. This retrospective study surrounding synchronous penile prosthesis implantation and urethral stricture disease management yielded high success and low complication rates.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on SpringerLink
  • Instant access to the full article PDF.

USD 39.95

Prices may be subject to local taxes which are calculated during checkout

Fig. 1: Management Framework Surrounding Treatment of Incidentally Found Urethral Stricture when Attempting Penile Prosthesis Placement.

Similar content being viewed by others

Data availability

Data regarding any of the subjects in the study has not been previously published. Available data will be made available to the editors of the journal for review or query upon request.

References

  1. Aytae IA, McKinlay JB, Krane RJ. The likely worldwide increase in erectile dysfunction between 1995 and 2025 and some possible policy consequences. BJU Int. 1999;84:50–6.

    Article  Google Scholar 

  2. Burnett AL, Nehra A, Breau RH, Culkin DJ, Faraday MM, Hakim LS, et al. Erectile dysfunction: AUA guideline. J Urol. 2018;200:633–41.

    Article  PubMed  Google Scholar 

  3. Darouiche RO. Treatment of infections associated with surgical implants. N Engl J Med. 2004;350:1422–9. https://doi.org/10.1056/NEJMra035415

    Article  PubMed  CAS  Google Scholar 

  4. Latini JM, McAninch JW, Brandes SB, Chung JY, Rosenstein D. SIU/ICUD Consultation On Urethral Strictures: Epidemiology, etiology, anatomy, and nomenclature of urethral stenoses, strictures, and pelvic fracture urethral disruption injuries. Urology. 2014;83:S1–7.

    Article  PubMed  Google Scholar 

  5. Alwaal A, Blaschko SD, McAninch JW, Breyer BN. Epidemiology of urethral strictures. Transl Androl Urol. 2014;3:209–13. https://doi.org/10.3978/j.issn.2223-4683.2014.04.07

    Article  PubMed  PubMed Central  Google Scholar 

  6. McGeorge S, Chung A, Desai DJ. Trends in urethral stricture management over two decades. BJU Int. 2019;124:37–41.

    Article  PubMed  Google Scholar 

  7. Wessells H, Angermeier KW, Elliott S, Gonzalez CM, Kodama R, Peterson AC, et al. Male urethral stricture: American urological association guideline. J Urol. 2017;197:182–90.

    Article  PubMed  Google Scholar 

  8. Moynihan MJ, Voelzke B, Myers J, Breyer BN, Erickson B, Elliott SP, et al. Endoscopic treatments prior to urethroplasty: trends in management of urethral stricture disease. BMC Urol. 2020;20:68.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Agha RA, Sohrabi C, Mathew G, Franchi T, Kerwan A, O’Neill N, et al. The PROCESS 2020 guideline: updating consensus preferred reporting of CasESeries in surgery (PROCESS) guidelines. Int J Surg. 2020;84:231–5. https://doi.org/10.1016/j.ijsu.2020.11.005

    Article  PubMed  Google Scholar 

  10. Cui WS, Kim SD, Choi KS, Zhao C, Park JK. An unusual success with simultaneous urethral repair and reimplantation of penile prosthesis in a patient with urethral stricture induced by rotated tubing. J Sex Med. 2009;6:1783–6. https://doi.org/10.1111/j.1743-6109.2009.01218.x

    Article  PubMed  Google Scholar 

  11. Song W, Wu Y, Yuan Y, Peng J, Zhang Z, Gao B, et al. One-Stage direct-vision internal urethrotomy and penile prosthesis implantation for severe erectile dysfunction with urethral stricture. Chonnam Med J. 2009;45:33–7.

    Article  Google Scholar 

  12. Yi YA, Fuchs JS, Davenport MT, McKibben MJ, Bergeson RL, Morey AF. Synchronous urethral repair during prosthetic surgery: safety of planned and damage control approaches using suprapubic tube urinary diversion. J Sex Med. 2019;16:1106–10. https://doi.org/10.1016/j.jsxm.2019.03.008

    Article  PubMed  Google Scholar 

  13. Anele UA, Le BV, Burnett AL. Suprapubic cystostomy for the management of urethral injuries during penile prosthesis implantation. Sex Med. 2014;2:178–81. https://doi.org/10.1002/sm2.44

    Article  PubMed  PubMed Central  Google Scholar 

  14. Steenkamp JW, Heyns CF, de Kock ML. Internal urethrotomy versus dilation as treatment for male urethral strictures: a prospective, randomized comparison. J Urol. 1997;157:98–101.

    Article  PubMed  CAS  Google Scholar 

  15. Heyns CF, Steenkamp JW, De Kock ML, Whitaker P. Treatment of male urethral strictures: is repeated dilation or internal urethrotomy useful? J Urol. 1998;160:356–8.

    Article  PubMed  CAS  Google Scholar 

  16. Rozanski AT, Zhang LT, Holst DD, Copacino SA, Vanni AJ, Buckley JC. The effect of radiation therapy on the efficacy of internal urethrotomy with intralesional mitomycin C for recurrent vesicourethral anastomotic stenoses and bladder neck contractures: a multi-institutional experience. Urology. 2021;147:294–8.

    Article  PubMed  Google Scholar 

  17. Karsli O, Ustuner M, Memik O, Ulukaradag E. Comparison of urethral dilation with amplatz dilators and internal urethrotomy techniques for the treatment of urethral strictures. Urol J. 2020;17:68–72.

    PubMed  Google Scholar 

  18. Habous M. Malleable (Semi-Rigid) penile prosthesis (MPP). J Sex Med. 2015;12:1984–8.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

We would like to thank the reviewers of this paper for providing helpful feedback.

Funding

This study was approved by the Johns Hopkins University Institutional Review Board (IRB00205900).

Author information

Authors and Affiliations

  1. The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Ankith P. Maremanda, William Du Comb, Mark Alshak, Harjit Singh Nalwa & Arthur L. Burnett

  2. Lahey Urological Institute, Lahey Medical Center, 41 Mall RD, 01805, Burlington, MA, USA

    William Du Comb

  3. University of Texas Medical Branch at Galveston School of Medicine, Galveston, TX, USA

    Corey Able

Authors
  1. Ankith P. Maremanda
    View author publications

    Search author on:PubMed Google Scholar

  2. William Du Comb
    View author publications

    Search author on:PubMed Google Scholar

  3. Mark Alshak
    View author publications

    Search author on:PubMed Google Scholar

  4. Harjit Singh Nalwa
    View author publications

    Search author on:PubMed Google Scholar

  5. Corey Able
    View author publications

    Search author on:PubMed Google Scholar

  6. Arthur L. Burnett
    View author publications

    Search author on:PubMed Google Scholar

Contributions

APM: Data Curation, Investigation, Visualization, manuscript writing and editing. WDC: Conceptualization, Data Curation, Investigation, Methodology, Visualization, manuscript writing and editing. MA: Manuscript writing and editing. HSN: Data Curation, manuscript writing. CA: Data Curation, Investigation, Visualization, manuscript writing and editing. ALB: Project development, manuscript editing, supervision.

Corresponding author

Correspondence to William Du Comb.

Ethics declarations

Competing interests

The authors declare no competing interests.

Ethics declaration

Ethics approval was not required for this study. No work was done on any live vertebrates regarding this study. As a retrospective chart review, informed consent was not required. No images from human research participants were obtained for this study.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Maremanda, A.P., Du Comb, W., Alshak, M. et al. Synchronous management of urethral stricture disease and penile prosthesis implantation: a case series. Int J Impot Res 37, 926–931 (2025). https://doi.org/10.1038/s41443-025-01049-y

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Version of record:

  • Issue date:

  • DOI: https://doi.org/10.1038/s41443-025-01049-y

Search

Advanced search

Quick links