There are two main methods of treatment after posterior urethral injury: 1. endoscopic treatment: including direct visualization endourethrotomy (DVIU) and urethral dilatation; 2. open surgery, including end-to-end anastomosis and urethral substitutionplasty. The choice of which method to use depends on the degree of urethral defect (stricture or atresia), the length of the defect, and the presence of comorbidities (e.g., urethral pseudo-tracts, fistulas). Open surgery for posterior urethral strictures is difficult; the local situation is complicated after multiple surgeries; and the presence of comorbidities adds to the complexity of management. Regardless of the surgical approach, it is extremely important to choose a surgical route that adequately exposes the posterior urethra. The choice of the surgical route for posterior urethral stricture is based on the length and severity of the stricture and the presence of comorbidities. Currently, the most commonly used surgical routes include the trans-perineal route, the trans-pubic route, or a combination of both. The transconjunctival approach is still the preferred surgical route for posterior urethral stricture because it is clinically familiar and has been widely accepted. The trans-pubic approach is considered only for repeated failures of the trans-perineal approach and for fistulas that do not heal over time.