Urethral rerouting around one side of corpora cavernosus via a perineal approach for treating long-segment, complex posterior urethral strictures.

Objective: To explore the value of urethral repair by using distant urethra rerouting around one side of corpora cavernosus via the transperineal inferior pubectomy approach for treating long-segment, complex posterior urethral strictures (LS-cPUS).

Patients And Methods: The clinical data of 37 LS-cPUS patients who were admitted to our department from May 2006 to June 2023 were retrospectively analyzed. Via a perineal approach, the procedure involved distal urethral mobilization, division of the median septum of corpus cavernosa, resection of the inferior pubic margin, and urethral repair by using distant urethra rerouting around one side of corpora cavernosus. The mean age of the patients was 28.9 years, with 24 patients having previously undergone one or more urethral repair procedures and 7 patients presenting with urethral-rectal fistulas.

Results: Of the 37 patients, 3 were lost to follow-up. The remaining 34 patients were followed for 9 months to 15 years after surgery (mean: 41 months). Thirty-one patients achieved unobstructed urination following surgery. Three patients developed recurrent urethral strictures, all of which were anastomotic strictures. Two of these patients were salvaged by a combined abdominal transpubic-perineal urethroplasty and a internal urethrotomy respectively, and the other patient underwent permanent cystostomy.

Conclusions: The urethral repair by using distant urethra rerouting around one side of corpora cavernosus has a high success rate in treating LS-cPUS. For young patients, especially children, it effectively minimizes secondary trauma to the corpora cavernosa, making it a feasible surgical technique.