The combined perineo-abdominal transpubic urethroplasty.

Research pertaining to transpubic urethral surgery is described. The operative technique of the perineo-abdominal transpubic approach for pelvic fracture urethral injury (PFUI) is reported in detail. Under all circumstances the operation should be started by a perineal exposure and liberal circumferential mobilisation of the bulbar urethra. The operation proceeds to an abdominal exposure only when a tension-free urethral anastomosis cannot be made from the perineal approach. An omental wrap of the urethral anastomosis is mandatory to guard against the surrounding fibrosis and callus formation. The operation might be indicated for PFUI with a long urethral gap when the urethral anastomosis cannot be made from the perineal approach, and in complex PFUI associated with an intra-abdominal complication. The combined perineo-abdominal transpubic procedure provides a wide and excellent exposure for an easy and neat bulboprostatic urethral anastomosis. Success rates are usually 98-100% and are sustained in the long term.