OBJECTIVE: Transperineal urethroplasty is the treatment of choice for pelvic fractures with posterior urethral distractions, especially in cases of long-segment defect of the urethra or cases which are challenging to urologists. We present our experiences and long-term follow-up results.MATERIALS AND METHODS: From 1993 through 1999, eight patients with severe post-erior urethral disruption due to pelvic fractures were treated at Tri-Service General Hospital (TSGH) in Taipei, Taiwan. All patients received initial suprapubic cystostomy and delayed transperineal urethroplasty. Clinical history including mechanism of injury, associated compli-cations and secondary operative procedures was recorded. Recurrence was determined using cystoscopy or retrograde urethrography and long-term voiding functions were determined using residual urine and uroflowmetry. Sexual functions were also determined using apatient ques-tionnaire RESULTS: The mean age was 29.4 years (range 23-50 years). The mean interval between suprapubic cystostomy and transperineal urethroplasty was 5.6 months (range 4-9 months). The mean urethral stricture length was 2.8 cm (range 1.5- 7 cm). During the follow-up period (range 17-73 months; mean 45.8), the overall postoperative re-stricture rate was 75% (6/8); 15 visual internal urethrotomies and 20 urethral dilations with sounds were performed subsequently. All eight patients now have patent urethras, and seven (87.5%) void well and are continent except one who has an underactive neurogenic bladder secondary to the injury. Erectile dysfunction (ED) was present both preoperatively and postoperatively in four (50%) of the patients. Of these, three had urethral re-stricture postoperatively.CONCLUSIONS: In our experience, the principal problem was re-stricturing which can usually can be treated by secondary urethrotomy or dilation. Re-stricture of the urethra was eas-ily noted in severely injured urethras. There were no changes in ED before or after operations. The long-term postoperative follow-up of voiding and sexual functions is mandatory.