M Parvizi - Department of Pediatric Surgery, Akbar Children’s Hospital, Mashhad University of medical sciences Iran
M Hiradfar - Department of Pediatric Surgery, Akbar Children’s Hospital, Mashhad University of medical sciences Iran
R Shojaeian - Department of Pediatric Surgery, Akbar Children’s Hospital, Mashhad University of medical sciences Iran

Background:Pelvic fracture is the most common cause of posterior urethral stricture in all ages, but it may occur due to congenital causes, infection or iatrogenic trauma in the pediatric group. There is still a technical challenge in posterior urethra reconstruction, which mostly dependssurgical approach is considered the best method for management in these cases. While perineal anastomosis urethroplasty may be able to bridge a gap of up to 4 cm, urethral substitution or transpubic urethroplasty may be needed in larger gaps. Substitution urethroplasty is considered in treatment of long, complex, recurrent posterior urethral strictures, especially after several failed explorations andrepairs. Unfortunately, the results of urethral substitution are not encoura anastomotic stenosis, diverticula and stone formation have been reported. Well vascularized conduit and tension-free anastomosis are the main factors that account for functional results, while the bed of the conduit is often fibrotic and avascular in recurrent complicated strictures.The colon, jejunum and appendix have been used as pedicled flaps in reconstruction of the posterior urethra. There are several reports of acceptable results in substitution of the posterior urethravascular pedicle. Methods:This article presents a modified technique and clinical outcome of two urethroplasty with appendix-free flap and microvascular anastomosis.Results: This modified technique may be a helpful alternative in those cases where the pedicled appendix does not reach the perineum, without applying tension on its vascular pedicle.