A modified perineal approach to reconstruction of membranous urethra for stricture.

Difficulty in obtaining perineal exposure of the membranous urethra in cases of traumatic stricture led to the development of the combined perineosuprapubic and transpubic approaches. Use of the standard perineal incision for perineal prostatectomy with division of the urogenital diaphragm in the midline from behind up to and encircling the urethra, and temporary suturing of the flaps of the urogenital diaphragm that are created to the lateral edges of the skin incision provides good exposure of the membranous and proximal bulbous urethra, thus, making reconstruction easier. This approach should minimize the need for the transpubic or perineosuprapubic approaches. It has been used for urethroplasty in 12 patients with traumatic membranous strictures, 5 with traumatic bulbomembranous strictures, 7 with post-gonococcal strictures involving the proximal bulbous and distal membranous urethra, and 1 with a bulbomembranous urethral rupture.