Transperineal bulbo-prostatic anastomotic urethroplasty.

Transperineal bulbo-prostatic anastomotic urethroplasty is the procedure of choice for the treatment of pelvic-fracture urethral distraction defects. Surgery is usually performed at 3-6 months after the injury. Endoscopic urethroplasty may prove to be an alternative if long-term follow-up confirms the initial enthusiasm for the procedure. Alternative urethroplasty techniques have not proved appropriate in long-term follow-up. The procedure depends on a progressive series of steps to capitalise on the elastisity of the urethra and then straighten out the natural curve of bulbar urethra. A retropubic or (truly) transpubic approach is rarely necessary except for complicated problems. The restricture rate is approximately 10% and is generally associated with poor vascularity. Other complications are generally the complications of the original injury rather than of the procedure itself.