Introduction: Urethral strictures and benign prostatic hyperplasia (BPH) are two causes of urinary obstruction. We present a case of a 75-year-old man with significant BPH (200 g) with a concomitant obliterative bulbar stricture that precluded a two-stage approach.

Methods: The holmium laser enucleation of the prostate (HoLEP) was performed through a perineal dorsal urethrotomy. Once the HoLEP was completed, the stricture was then examined and found to have a long obliterative segment. A non-transecting anastomotic repair of 2 cm was then combined with a 5 cm dorsal buccal onlay urethroplasty. Total stricture length was 7 cm.

Results: The patient did not have any acute postoperative complications.  Preoperative and Postoperative urethrograms are shown (Figures 1, 2). Following removal of his urethral catheter one month postoperatively, the patient was found to have some residual prostate fragments in his bladder that were removed in the outpatient clinic. At three months postoperatively, the patient was voiding well (maximal flow rate of 14 mL/s) and had no evidence of recurrence on cystoscopy. Although having a favorable urethral stricture surgery patient-reported outcome measure lower urinary tract symptom (USS PROM LUTS) score of 5, he did report some rare postvoid dribbling. His Peeling's voiding picture score was 3, and he was very satisfied with his surgery.

Conclusions: To our knowledge, this is the first case reporting simultaneous complex urethroplasty and HoLEP for a long obliterative urethral stricture and concomitant BPH. This case report shows that this approach can lead to successful outcomes and high satisfaction at three months postoperatively.