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.
When This Pointer Exists
This page exists because the VUAS database includes "transperineal reanastomosis" as a distinct named option, while the full operative content belongs on the broader Primary Re-Anastomosis page. Keeping a narrow pointer prevents duplicated outcome tables while still giving database users a stable target.
Selection Snapshot
| Favor TPRA | Prefer another approach |
|---|---|
| Already incontinent patient who will need delayed AUS regardless | Preoperatively continent patient where continence preservation is central |
| Hostile abdomen / prior abdominal reconstruction limits retropubic access | Reconstructible short VUAS with feasible robotic transvesical or retropubic approach |
| Obliterative, highly recurrent VUAS where perineal mobilization is needed | Radiation-associated VUAS where non-transecting dorsal BMG is feasible |
| Last orthotopic-outlet option before diversion | Patient unwilling to accept staged AUS pathway |
Operative Logic
The operation borrows from posterior urethroplasty: perineal exposure, proximal urethral mobilization, scar excision, and tension-free mucosa-to-mucosa reanastomosis. Longer gaps may require progressive perineal maneuvers such as corporal separation or partial inferior pubectomy. In the post-prostatectomy patient, the continence mechanism is already vulnerable, so the operation should be framed as outlet patency first and continence restoration later.