Transperineal Reanastomosis

Transperineal reanastomosis uses perineal access, scar excision and proximal urethral mobilization to reconnect the urethra to the bladder outlet. It can address selected highly recurrent or obliterative VUAS when the anatomy favors access from below. See primary reanastomosis for operative principles and the original cohorts.

Post-prostatectomy redo VUA differs from PFUI repair: the continence mechanism is already vulnerable, and transperineal reconstruction carries a substantial risk of new or worsened SUI. Counsel about possible staged AUS placement, after stable patency and bladder function are established. Neither a universal 83.3% risk nor mandatory AUS for every already-incontinent patient is justified from small selected cohorts.^[1]

Selection depends on stenosis length and location, available urethra, prior operations/radiation, abdominal access, bladder function, baseline continence and the patient's priorities. Progressive perineal maneuvers or a combined approach may be needed for a tension-free repair. Graft, flap, retropubic, transvesical and diversion options address different defects; none should be preferred solely by comparing percentages from unrelated case series.^[1]

References

1. European Association of Urology. EAU Guidelines on Urethral Strictures. 2026. Disease management in males, sections 6.3.5–6.3.6. Guideline.