PURPOSE: We evaluated an endoscopic technique to treat the challenging problem of an obliterated anastomosis following radical prostatectomy. MATERIALS AND METHODS: Four men with a mean 2.25 cm. obliterative defect underwent visual internal urethrotomy along a sternal guide wire passed under direct antegrade and retrograde vision. Men then performed self-dilation according to an increasing interval protocol. RESULTS: All 4 men maintained anastomotic patency for a mean followup of 12.5 months and 1 no longer requires self-calibration. There were no complications of this procedure. CONCLUSIONS: Endoscopic management coupled with self-dilation offers a safe, minimally invasive option for difficult, long obliterative anastomotic defects following radical prostatectomy.