Gomez Technique Combined With Modified Hosseini Technique: Two Underrecognized Techniques Toward a Potential Gold Standard for Posterior Anastomotic Urethroplasty

Sparing of the bulbar arteries during posterior post-traumatic urethroplasty remains a relatively underrecognized technique, despite evidence demonstrating its role in preserving urethral vascularization, a critical determinant of optimal healing. This consideration is particularly important given that urethral necrosis, although rare, may lead to severe complications, including fistula formation, stricture recurrence, or even complete urethral loss. To facilitate accurate proximal delineation of fibrotic tissue during stricture resection, we describe a modified Hosseini technique, which appears to be a reliable and safe approach. In contrast to the original description, which utilized a fine needle, a gray venous catheter is introduced, allowing the passage of a hydrophilic guidewire. Progressive dilation over the guidewire enables controlled and safe resection under direct vision until healthy proximal urethral tissue is clearly identified. While sparing the bulbar arteries has been demonstrated to be a rational approach whenever feasible, its combination with our modified Hosseini technique appears, based on our experience, to be feasible, reproducible, and conducive to a faster and more straightforward surgical execution.