Transperineal Re-Anastomosis (TPRA)

Perineal approach to excise the strictured vesicourethral anastomosis and create a tension-free reanastomosis. Mirrors the perineal approach to PFUI repair; preferred when prior abdominal surgery makes transabdominal access difficult, or as a last option before urinary diversion in highly recurrent VUAS. The TPRA approach has high patency (87% at 45 mo, Schuettfort 2017) but the AUA reports an 83.3% de novo incontinence rate in preoperatively continent patients — substantially higher than retropubic or robotic approaches. For this reason TPRA is generally reserved for patients who are already incontinent and will require AUS regardless.

For the comprehensive operative description, comparative outcomes (Reiss 2014, Schuettfort 2017), and side-by-side comparison with open retropubic, robotic retropubic, and robotic transvesical approaches, see Primary Re-Anastomosis.