Perineal anastomotic urethroplasty for pelvic fracture urethral injury^[1]

Perineal anastomotic urethroplasty is performed in a stepwise fashion. A midline perineal incision is taken down to identify the urethra, which is mobilized circumferentially (A). The urethra is transected and mobilized to the suspensory ligament of the penis. The proximal urethral stump is identified using a combination of endoscopy from above (via suprapubic tube tract) and palpation and mobilized; separating the proximal corporal bodies shortens the needed urethral length by 1 to 2 centimeters (B). Inferior wedge pubectomy further shortens the required length by another 1 to 2 centimeters (C). Rerouting of the urethra above the corporal body is rarely needed but can further shorten the length of the defect for repair (D).