The invention provides a device for urethral anastomosis, for example, following prostatectomy. The device has a flexible slender shaft including a flexible outer sleeve and a flexible inner sleeve inside a lumen of the outer sleeve. A bladder anchoring system anchors the distal end of the inner sleeve inside a urinary bladder, and a urethral anchoring system anchors the outer sleeve in a urethral stump. A ratchet mechanism allows proximal movement of the inner sleeve inside the outer sleeve while preventing distal movement of the inner sleeve inside the outer sleeve. The device is used to urge the urinary bladder towards the internal termination of the urethra to allow anastomosis of the bladder neck to the urethral stump.