The transpubic approach for strictures of the membranous urethra

Strictures of the membranous urethra following pelvic fractures pose a challenge in management because of their relatively inaccessible position above the urogenital diaphragm and behind the pubic symphysis. The corrective procedures the pass up from the perineum through the urogenital diaphragm to reach the stricture have the real or theoretical disadvantage of defunctionalizing the external urethral sphincter and leaving continence dependent solely upon the competency of the bladder neck. On the other hand, transpubic surgery allows a direct attack upon the stricture without violating the sphincter. Our experience with 4 such cases has convinced us of the superiority of this approach.