Posterior urethral stricture repair.

Experience with 54 operations for the membranous-prostatic urethral stricture is presented. There were 7 operations performed through pubectomy exposure, 6 Badenoch operations, 31 exteriorization 2-stage operations using a perineal-scrotal flap for the first state and 10, 1-stage transperineal end-to-end anastomoses after scar tissue had been excised. The technique for the transperineal approach is presented. Presently, a 1-stage end-to-end anastomosis of the bulbomembranous urethra to the prostatic urethra through a perineal approach is preferred. Exteriorization urethroplasty using the perineal-scrotal flap is recommended when an end-to-end anastomosis is not feasible, either because of a long stricture or severe scar secondary to previous operative failures. The pubectomy approach is seldom needed but the Waterhouse pubectomy procedure is recommended as a possibility in patients who cannot be placed in the exaggerated lithotomy position.