Perineal Urethrostomy

Perineal urethrostomy is a surgery that creates a new opening from your urethra (the tube that pee drains from) to the outside of your body. A surgeon creates the new opening in your perineum, the area of skin between your scrotum and anus (butthole). This reroutes your urethra and replaces the opening at the tip of your penis.

Why is perineal urethrostomy done?

You might need a perineal urethrostomy if you have a narrowing in your urethra (urethral stricture) that’s blocking the flow of pee out of your body through your penis. Infection, injury or previous surgery can cause scarring of your urethra that leads to a stricture. It can partially or completely block the flow of urine.

Surgeons might suggest a perineal urethrostomy if you have a narrowing of your urethra in your penis and:

• Your urethra can’t be repaired to allow pee to drain from the end of your penis.
• You don’t want to have extensive reconstructive surgery.
• Other types of surgery, like urethroplasty, haven’t been successful at correcting the stricture.

What conditions is perineal urethrostomy used in?

Perineal urethrostomy may be an option for people who have:

• Complex or recurrent urethral strictures
• Squamous cell carcinoma of the penis
• A condition where the urethral opening is on the underside of their penis instead of the tip (hypospadias)
• Had their penis surgically removed (penectomy)
• Had all or part of their urethra removed (urethrectomy)
• Had surgery for Fournier’s gangrene

How do I prepare for a perineal urethrostomy?

Your provider will give you instructions on how to prepare for perineal urethrostomy. Following their directions closely can reduce your risk of complications.

Before perineal urethrostomy, your provider may ask you to:

• Provide a pee sample for analysis.
• Start a course of antibiotics to prevent urinary tract infections.
• Not eat or drink anything (fast) for a certain amount of time before the procedure.
• Not take certain medications or alter your medication schedule. Don’t stop taking medications unless your provider tells you to.
• Arrange to spend a few days at the hospital and plan for someone to drive you home.

Tell your healthcare provider:

• About any medications you take, including supplements
• If you have an implanted medical device, like a joint replacement, artificial heart valve or pacemaker

What happens during perineal urethrostomy?

Just before your procedure, your provider may get X-rays of your urethra. An anesthesiologist will give you general anesthesia so you’ll be asleep during the surgery.

There are several ways your provider can perform a perineal urethrostomy. During the Blandy technique, which is the most common way, a surgeon will:

1. Make an inverted U-shaped incision (cut) in your perineum just underneath your scrotum, creating a flap.
2. Make a lengthwise incision of about 3 to 4 centimeters into your urethra.
3. Suture (sew) the perineal flap to your urethra and around it to create a new external urethral opening.
4. Place a Foley catheter (draining tube) into your bladder through the urethrostomy to drain pee.

How long does this procedure take?

Perineal urethrostomy takes one to three hours.

What happens after perineal urethrostomy?

You’ll spend a few hours recovering from anesthesia after the procedure. Then, you’ll need to stay in the hospital for two to three days before you can go home. Ask your provider what to expect while you stay in the hospital.

Before you leave the hospital, your provider may:

• Give you instructions on how to take care of yourself at home.
• Arrange an appointment to remove your catheter. The catheter usually stays in place for two to three weeks following surgery.
• Prescribe any antibiotics or pain medications you may need.
• Schedule follow-up appointments.

Are there any complications associated with a perineal urethrostomy?

Every surgery has risks, though complications from perineal urethrostomy are rare. They include:

• Bleeding from the incision
• Swelling
• Infection at or around the incision
• Urinary tract infection (UTI)
• Recurrence of the urethral stricture or narrowing, which would require more surgery

You may also experience:

• Inability to completely empty your bladder
• Low urinary flow rate
• Erectile dysfunction

What is the recovery timeline for perineal urethrostomy?

You’ll probably need to wait two to three weeks after a perineal urethrostomy before returning to your regular routine. During that time, you may need to avoid certain activities, like sex, driving or heavy lifting. Your provider will let you know how to take care of yourself.

You’ll likely experience some pain or discomfort during recovery. Your provider will prescribe pain medications or recommend over-the-counter pain relievers. Talk to your provider if the pain is more than you can manage with prescription or over-the-counter medications.

You’ll have regular follow-ups with your provider. They might:

• Perform a urethroscopy eight to 12 months after the procedure to check the health of your urethra.
• Measure your urinary flow rate and residual urine every six to 12 months.

What can I expect after perineal urethrostomy?

After the procedure, you’ll need to sit down to pee. This can take some getting used to.

Talk to your provider about any changes you’ll need to make to your toileting routine — like how to wipe after peeing or pooping — to make sure the area stays clean and hygienic.

What is the prognosis (outlook) for people who have a perineal urethrostomy?

According to studies, between 70% and 90% of people who underwent perineal urethrostomy didn’t need any additional corrective surgeries. Many people report an improved quality of life after the procedure.

When should I call my healthcare provider?

Contact your healthcare provider right away if you have:

• Heavy bleeding from the incision
• Swelling at the incision
• Fever
• A frequent need to pee
• The feeling that you haven’t completely emptied your bladder when you pee
• Low urine flow

Who isn’t a good candidate for a perineal urethrostomy?

Perineal urethrostomy isn’t a good fit for everyone. You might not be a good candidate if you:

• Have obesity
• Have had perineal surgery before
• Have had radiation treatments for prostate cancer

Will I still ejaculate through my penis?

Ejaculated semen will pass through the new opening instead of your penis.

Will this procedure make me incontinent?

No. The group of muscles that allows you to control your pee is above the opening.