Chief complaint, medical history Patient, male, 20 years old, had difficulty urinating after trauma for 16 years. The patient had a traumatic injury 16 years ago and was diagnosed with traumatic urethral atresia and had undergone 3 urethral end-to-end anastomoses after cystostomy (the last surgery was in 2008). The patient’s urethral opening was under the scrotum and perineum, unable to control urine, and urine flowed out on its own Urethrography only showed a false tract, and only a short penile urethra, about 5 cm long, remained in the normal urethra Diagnosis and management Elective subpubic rim resection + scrotal flap substitution urethroplasty + urethral bladder dragging in Surgical procedure: Inverted Y-shaped perineal incision incision was made, including the perineal urethrostomy, and the penile urethra was seen intraoperatively The urethral-penile skin fistula was present, and the fistula was excised. The posterior urethra was separated, and the posterior urethral scar was obvious and was attached to the pubic bone, with severe local adhesions. Considering the possibility of a pseudo-tract, a 4-cm longitudinal incision was made on the pubic bone, and an exploration of the bladder revealed another internal orifice 1 cm anterior to the current urethral orifice, which was blind, and the blind end was completely obscured by the deformed pubic bone. The cystoscope was used to explore the blind channel, and it was found that the bladder muscle sphincter function of the blind port was good, so it was inferred that it was a true urethra, and the flap of the left scrotum and the root of the thigh about 8cm*3cm in size was used to separate the tissue vessels under the flap to form a vascular tip, and the flap was turned over to form a urethra, and the proximal end of the flap urethra was dragged into the bladder, and the true urethra was found to be in contact with the true urethra. The proximal end of the flap urethra was dragged into the bladder and sutured with a straight needle at the mucosa of the true urethral bladder. The distal end of the flap urethra was also sutured to the normal urethral mucosa in the penis, and a Foley 14 catheter was left in place, and a Foley 14 catheter was left in place in the urethra at the prosthesis. Follow-up and discussion The urethral catheter was removed 6 weeks after surgery, and the patient voided freely without incontinence, with a urinary flow rate of 17 ml/s. The catheter in the prosthetic channel was removed 8 weeks after surgery, and the prosthetic channel closed on its own 2 weeks after removal of the catheter. This patient had a long urethral defect and the urethral fracture was completely obscured by the deformed pubic bone, so the prosthetic channel was formed by anastomosis from below the bone during the external surgery. After this surgery, the normal urethral structure, and the position of the internal urethral opening were restored, so the symptoms of urinary incontinence disappeared. However, the surgery was extremely difficult, and there was no room for manipulation during the suture, and after the bone was chiseled away, only a straight needle dragged into the suture could be performed. However, the anastomosis is more exact, so the postoperative results are good.