Re: Simplified Reconstruction of Posterior Urethral Disruption Defects: Limited Role of Supracrural Rerouting

EDITORIAL COMMENT Posterior urethroplasty technique for traumatic posterior urethral defects has a success rate of 90% in experienced hands (1,2). The authors reviewed the records of 142 patients who underwent reconstruction of traumatic posterior urethral defects with greater than 1 year of follow-up from 5 teaching hospitals. Prior treatments, surgical approach and ancillary techniques required during reconstruction were compiled. Direct anastomosis following scar excision and urethral mobilization alone was performed in 95 of the 142 males (67%). Corporal splitting was performed in 24 patients (17%) and inferior pubectomy in was done in 14 (10%). Supracrural urethral rerouting was performed in only 4 patients (3%), of whom 3 (75%) experienced recurrent stenosis. Abdominoperineal reconstruction, which was reserved mainly for salvage and pediatric cases, was required to reconstruct complex defects in 5 of the 142 cases (4%) and it was successful in 4 (80%). Overall successful posterior urethral reconstruction was achieved in 130 of 142 cases (92%). Eight failures were successfully managed by internal urethrotomy (2) or repeat urethroplasty. The authors concluded that corporal splitting or inferior pubectomy are rarely required for successful posterior urethral reconstruction. Urethral rerouting appears to be inferior to the abdominoperineal approach as a salvage tecnique for complex cases.