History and Evolution of Transpubic Urethroplasty: A Lesson for Young Urologists in Training

Eur Urol 2007; 52: 1290-1292.
The history and evolution of the use of the transpubic approach for posterior urethroplasty in patients with pelvic fracture urethral distraction defects (PFUDDs) can be summarized within two different time periods.
In 1962, Pierce first described the ‘‘splendid’’ exposure of the posterior urethra by total abdominal pubectomy, but he later abandoned this approach because of postoperative problems and several failures [1,2]. In 1968, Paine and Coombes described a direct transpubic excision of the stricture asso- ciated with primary end-to-end anastomosis of the urethral ends, using a single abdominal incision [3]. In 1973, Waterhouse et al described a new approach using a perineal incision for mobilization of the anterior urethra and an abdominal incision for transpubic anastomosis between the bulbar urethra and the prostatic apex [4]. In 1976, Turner-Warwick suggested using an omental wrap to provide vascular and trophic support to the transpubic bulboprostatic anastomosis [5]. In the 1970s and into the 1980s, the perineal-abdominal transpubic urethroplasty was considered the gold standard in the majority of adults and children suffering from PFUDDs [6–10], showing traumatic strictures that Turner-Warwick described as complex [11].
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