Application of transpubic approach in the management of lower urinary tract pathology in 110 patients. A critical review.

The male lower urinary tract, which comprises the bladder neck, prostate and membranous urethra, is well hidden behind the pubic symphysis. Historically, surgeons have attempted to expose this part of the anatomy by removing the pubic symphysis, in part or in total, during the surgical procedure. In 1923, for the first time, Walker from Australia attempted to obtain better access to the prostate to treat prostatic cancer. Since the surgeons have utilized transpubic approach in a variety of surgical pathologies. We present our experience in managing 110 patients of both sexes ranging in age from 6 to 70 years. They presented with different lower genitourinary tract pathologies, with prostatomembranous strictures comprising 77% of the cases. Clinical indications for transpubic approach, crucial surgical principles, complications of the procedure, and, more importantly, long term evaluation of patients for 10 years or more, is presented. Transpubic approach has an ongoing role in the surgical and urological management both in children and adult patients of both sexes. Transpubic approach is a safe technique with minimal long-term complications and no post-operative orthopedic sequelae.