Difficulty : ⭐️⭐️
This is the easiest enlargement urethroplasty to perform.
Indeed, at the bulb level, the urethra is not in the centre of the spongiosa but in depth: it can be opened on its superficial side and then grafted by the mucosa which will be covered very easily by the spongiosa closed in situ.
The relative ease with which this procedure can be carried out has a pitfall: the surgeon tends to underestimate the top of the stenosis!
In summary: indications for onlay grafting are rare because bulbar stenosis often reaches the membranous side and, in case of doubt, it is much wiser to open the urethra on the cavernous side, which allows to adapt to all situations.
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