Posttraumatic Long-Segment Bulbar Urethral Stricture Treated With Perineal End-to-End Urethroplasty: A Case Report.

Posttraumatic urethral strictures following pelvic fractures represent a complex urological challenge that requires precise imaging, careful surgical planning, and evidence-based perioperative care. We present the case of a 45‑year‑old male patient with a suprapubic cystostomy placed one year earlier after a pelvic fracture, admitted for definitive management of urinary retention caused by a complete obstruction of the bulbar urethra. Antegrade urethrography revealed a long‑segment bulbar obliteration of approximately 3-5 cm. Surgical treatment consisted of perineal end‑to‑end urethroplasty over a 16 Ch Foley catheter using interrupted 5‑0 Monocryl sutures. A single preoperative dose of IV gentamicin (5 mg/kg) was administered 60 minutes before skin incision. Postoperatively, the Foley catheter was maintained for 14 days; enoxaparin 4,000 IU was given daily during hospitalization for thromboprophylaxis; and trimethoprim 100 mg was prescribed nightly for 14 days. Supportive care included nonsteroidal anti-inflammatory drugs (NSAIDs)/acetaminophen for analgesia, hydration of 2-3 L/day, and activity restriction for 4-6 weeks. On postoperative day 2, the patient was discharged asymptomatic with good perineal wound healing and a well‑positioned suprapubic catheter. He was scheduled for catheter removal and outpatient assessment after 14 days. The patient provided written informed consent for publication. This case underscores the importance of antegrade imaging for surgical planning, meticulous technique for tension‑free anastomosis, and perioperative protocols that collectively optimize outcomes in complex urethral reconstruction.