This article recounts the story of a Californian urologist who was shot dead two decades later by a patient who was diagnosed with stricture of the urethra. The patient underwent surgery for urethral stricture in 1992 by a team (ironically, the procedure was not done by the doctor in question). Since the operation, the patient was not satisfied, repeatedly arguing with medical and nursing staff and visiting several other urologists. He was convinced that the procedure had caused damage to his prostate leading to incontinence, erectile dysfunction, a reduced sex drive and the subsequent loss of his long-term girlfriend. Whatever went wrong in his life he apparently blamed on the procedure. At the hearing, he pleaded not guilty by reason of insanity. However, the jury rejected his plea and he was sentenced to life imprisonment without parole. Although an extreme case, we should always remember the axiom ‘once a stricture always a stricture’ and thus, such patients need detailed and extended counselling and informed consent.