Nowadays, short bulbar strictures refractory to one endoscopic treatment attempt could be managed with non-transecting urethroplasty technique as a first option.<sup>1Chapman DW, Cotter K, Johnsen NV, et al. Nontransecting techniques reduce sexual dysfunction after anastomotic bulbar urethroplasty: results of a multi-institutional comparative analysis J Urol 2019 ;  201 : 364-37010.1016/j.juro.2018.09.051 [cross-ref]

Cliquez ici pour aller à la section Références</sup> Jordan et al<sup>2Jordan GH, Eltahawy EA, Virasoro R. The technique of vessel sparing excision and primary anastomosis for proximal bulbous urethral reconstruction J Urol 2007 ;  177 : 1799-1802 [cross-ref]

Cliquez ici pour aller à la section Références</sup> and Bugeja et al<sup>3Bugeja S, Andrich DE, Mundy AR. Non-transecting bulbar urethroplasty Transl Androl Urol 2015 ;  4 : 41-5010.3978/j.issn.2223-4683.2015.01.07

Cliquez ici pour aller à la section Références</sup> described a dorsal approach, sparing vessels, and spongiosum in the hope of a decrease of surgical side effects.

To describe the step-by-step technique of the ventral approach for the non-transecting bulbar urethroplasty in distal and mid short bulbar strictures.

We performed a prospective observational study of a cohort of patients who underwent a ventral non-transecting bulbar urethroplasty for short mid or distal bulbar strictures from January 2016 to December 2018. We included 10 patients.Surgical technique.A ventral midline urethrotomy is made and extended to assure a good caliber lumen both distally and proximally (20 Fr). The mucosal scar tissue is marked and a mucosectomy is performed, preserving the spongiosum.We bring the distal and proximal edges of healthy mucosa together without tension with a 5/0 absorbable monofilament. Ventral stricturotomy is closed over a 20F catheter, in a Heinike-Mikulics fashion, with 5/0 absorbable monofilament for the mucosal anastomosis and a 4/0 absorbable monofilament for the spongioplasty.

Mean age was 56,50 years (+/-17,27) and mean stricture length was 1,06cm (+/-1,82). The majority of strictures (90%) were located in the mid bulb. After a mean follow up of 27,25 months (+/-12,12), 9 patients remain recurrence-free (87,5%). A significant mean increase in Qmax was observed (12+/-4,53 ml/s, p=0,04). Urethral Stricture Surgery Patient-Reported Outcome Measure (USS-PROMS), items (Questions 1-6) related to urinate symptoms also showed a significant improvement(p=0,03). We didn't find any significant decrease in erectile function with this technique.

The ventral approach for mid and distal short bulbar strictures is a feasible and reproducible technique with a significant increase in Qmax and improvement in USS-PROMS. Preliminary results show no decrease in erectile function.