World Journal of Urology

, Volume 36, Issue 8, pp 1267–1274 | Cite as

Perineal midline vertical incision verses inverted-U incision in the urethroplasty: which is better?

  • Yifei Lin
  • Deyi Luo
  • Banghua Liao
  • Tongxin Yang
  • Ye Tian
  • Tao Jin
  • Guiming Wang
  • Hongying Zhou
  • Hong Li
  • Kunjie Wang
Original Article



To compare postoperative outcomes between the perineal inverted-U and the vertical midline incision approaches of the urethroplasty and clarify them via gross anatomy.

Patients and methods

A total of 461 male patients, from Jan. 2006 to Jun. 2014, who underwent the urethroplasty via perineal midline vertical or inverted-U incision approach were recruited retrospectively. By match pairing for etiology and stricture length, 410 patients from two groups (205 for each group) were selected. Anatomy experiments were also performed. Outcome measurements and statistical analysis: the Chi-square, Student’s t and binary logistic regression analyses were performed to compare the operative and postoperative data on the two groups.


With regard to patients with bulbar urethral stricture, the rate of surgical site infection (SSI) in perineal inverted-U group was 18.6% while 1.9% in the midline vertical group (p < 0.001). As for patients with posterior urethral stricture, the rate of SSI in the perineal inverted-U group was 16.4% while 3.1% in the midline vertical group (p = 0.001). Mean hospital stay between both groups were 15.8 ± 9.0 vs. 12.7 ± 3.8 days (p < 0.001). Anatomy experiments showed the number of damaged vessels and nerves involved in the inverted-U incision were approximately 1.6 to 2.0 folds more than the vertical midline, but the visual operation fields are similar between two approaches.


The perineal midline vertical incision is a safer approach with fewer SSI and shorter hospital stay than the perineal inverted-U incision for bulbar and posterior urethroplasty.


Urethroplasty Incision approach Surgical site infection Midline Inverted-U 



Our special thanks are due to Prof. Guanjian Liu and Prof. Liang DU from Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, for his help for design of methods. This study was supported by Grant No. 31170907, No. 31370951, No. 81470927 and No. 81300579 from the National Natural Science Foundation of China, Grant No. 2014SCU04B21 from Fund for Distinguished Young Scholars of Sichuan University, Grant No. JH2014053 from Academic Leader Training Fund of Sichuan Province and Grant No. JH2015017 from Application-oriented Foundation of Committee Organization Department of Sichuan Provincial Party.

Author’s contribution

KW had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: YL, DL, KW. Acquisition of data: YL, DL, TY, GW, HZ. Analysis and interpretation of data: YL, DL, TY. Drafting of the manuscript: YL, DL, TY. Critical revision of the manuscript for important intellectual content: BL, YT, TJ. Statistical analysis: YL, DL. Obtaining funding: DL, KW, HL. Administrative, technical, or material support: KW, HL. Supervision: KW, HL. Other: None.


This study was supported by Grant No. 31170907, No. 31370951, No. 81470927 and No. 81300579 from the National Natural Science Foundation of China, Grant No. 2014SCU04B21 from Fund for Distinguished Young Scholars of Sichuan University, Grant No. JH2014053 from Academic Leader Training Fund of Sichuan Province and Grant No. JH2015017 from Application-oriented Foundation of Committee Organization Department of Sichuan Provincial Party.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

For this type of study formal consent is not required.

Informed consent

For this type of study formal consent is not required.

Supplementary material

345_2018_2267_MOESM1_ESM.jpg (486 kb)
Supplementary material 1 (JPEG 486 kb) Two approaches of perineal incision: inverted-U (A) and midline (B).
345_2018_2267_MOESM2_ESM.docx (77 kb)
Supplementary material 2 (DOCX 76 kb) Flow diagram of the study enrollment.
345_2018_2267_MOESM3_ESM.docx (15 kb)
Supplementary material 3 (DOCX 14 kb) Categories of surgical site infection.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Urology Department, Institute of Urology (Laboratory of Reconstructive Urology), West China HospitalSichuan UniversityChengduPeople’s Republic of China
  2. 2.Department of Human Anatomy, West China School of Preclinical and Forensic MedicineSichuan UniversityChengduChina

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