Simplified reconstruction of posterior urethral disruption defects: limited role of supracrural rerouting

J Urol. 2007 Apr;177(4):1378-81; discussion 1381-2. doi: 10.1016/j.juro.2006.11.036.


Purpose: We present our combined experience with a simplified posterior urethroplasty technique to determine the necessity and usefulness of ancillary reconstructive maneuvers.

Materials and methods: We reviewed the records of 135 men and 7 boys who underwent reconstruction of traumatic posterior urethral defects with greater than 1 year of followup from 5 tertiary teaching hospitals. Prior treatments, surgical approach and ancillary techniques required during reconstruction were compiled.

Results: Direct anastomosis following scar excision and urethral mobilization alone was performed in 95 of the 142 males (67%). Formal corporal splitting was performed in 24 patients (17%) and inferior pubectomy in was done in 14 (10%). Supracrural urethral rerouting was performed in only 4 patients (3%), of whom 3 (75%) experienced recurrent stenosis. Abdominoperineal reconstruction, which was reserved mainly for salvage and pediatric cases, was required to reconstruct complex defects in 5 of the 142 cases (4%) and it was successful in 4 (80%). Early urethral realignment was associated with successful subsequent reconstruction in all patients in whom this maneuver was achieved (17 of 17 or 100%). This maneuver tended to be straightforward. Overall successful posterior urethral reconstruction was achieved in 130 of 142 cases (92%). Eight failures were successfully salvaged by internal urethrotomy (3) or repeat urethroplasty (5).

Conclusions: Ancillary maneuvers such as corporal splitting or inferior pubectomy are seldom required for successful posterior urethral reconstruction. Urethral rerouting appears to be inferior to the abdominoperineal approach as a salvage maneuver for complex cases. Primary realignment appears to promote more simplified and successful surgical repair.

MeSH terms

  • Adolescent
  • Adult
  • Anastomosis, Surgical / methods
  • Humans
  • Male
  • Prospective Studies
  • Retrospective Studies
  • Urethra / injuries*
  • Urethra / surgery*
  • Urethral Stricture / etiology
  • Urethral Stricture / surgery*
  • Urologic Surgical Procedures / methods