Summary: Surgical repair of post-traumatic complex posterior
urethral distraction defects remains one of the most challenging
problems in urology.
Objective: To show that partial inferior pubectomy combined with the abdominal-perineal approach is an alternative in the
management of post-traumatic complex posterior urethral
Design: Retrospective case series.
Interventions: 9 patients who had treatment failure in previous
attempts of transperineal repair of post-traumatic posterior
urethral distraction defects from January 2003 to September 2006.
Partial inferior pubectomy combined with the abdominal-perineal
approach was used in all patients. The median operating time was
301 minutes and the median hospital stay was 13 days. All patients
were followed up for 18 months. Follow-up evaluations included
voiding, urethrography, and uroflowmetry, which were carried
out postoperatively at 3, 6, 12, and 18 months.
Results: Seven patients had successful outcomes as demonstrated
by satisfactory uroflowmetry (median Qmax: 15 mL/s),
urethrography, and subjective improvement in the voiding
pattern. One patient developed slight urethral stricture and
one patient had the problem of hair in the urethra that was
successfully managed by a second surgery. Partial inferior
pubectomy combined with the abdominal-perineal approach is
a good alternative for repair of post-traumatic complex posterior
urethral distraction defects. It is safe and has the advantage of
better visualization of the apex of the prostate and the surgical
field, and may shorten the length of the reconstructed urethra,
with subsequent good outcomes, without immediate or remote
effects on the stability of the pelvis or bladder.