Perineal Urethrostomy

What is a perineal urethrostomy?

Perineal urethrostomy is a surgical procedure that is performed on males to create a permanent opening into the urethra through an incision in the skin of the perineum. The perineum is the area of skin between the scrotum and the anus. The urethra is the tube like structure through which urine passes from the bladder through the penis to exit the body.

Urine stored in the bladder normally passes through the urethra and flows out of the opening at the end of the penis during urination. However, infection, injury, or previous surgery may cause scarring of the urethra. This may result in a narrowing of the urethra, which is known as a urethral stricture. It can cause the flow of urine to become partially or completely blocked.

Why is a perineal urethrostomy performed? Who needs it?

A perineal urethrostomy may be done in cases where a patient has had other types of surgery to address a urethral stricture without success. It’s considered in cases where the urethra cannot be repaired to allow voiding through the end of the penis. After the new opening for urine to pass is created, males urinate in a seated position since urine will flow out of the body through the opening that is made in the perineum.

The procedure may also be an option for older men with anterior urethral strictures who prefer not to undergo extensive reconstructive urethral surgery.

There are different conditions in which a perineal urethrostomy may be an option:

• Complex and/or recurrent urethral strictures.
• Squamous cell carcinoma (cancer) of the penis.
• Penectomy: Surgical removal of the penis.
• Urethrectomy: Surgical removal of part or all of the urethra.
• Hypospadias: A congenital defect in which the opening of the penis (penile meatus) is on the underside of the penis instead of the tip.
• Failure of previous reconstructive procedures, such as urethroplasty.
• Surgical resection following Fournier’s gangrene of the penis and scrotum.

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

Some cases are more difficult than others. You might not be a good candidate for a perineal urethrostomy if you:

• Are morbidly obese.
• Have had perineal surgery before.
• Have had radiation for prostate cancer.

Will I still ejaculate through my penis?

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

Will this procedure make me incontinent?

No. The group of muscles that allows you to control when you urinate is above the opening. You will have control.

How do people prepare for a perineal urethrostomy?

Before surgery is performed, the patient will need to provide a sample of urine for analysis. Patients are given broad-spectrum antibiotics before undergoing surgery to prevent urinary tract infections. X-rays of the urethra are usually performed to outline the condition of it prior to surgery.

Tell your healthcare provider if you have the following:

• An implant like a stent, joint replacement, pacemaker, heart valve, or blood vessel graft.
• An MRSA infection.
• A high-risk of variant-CJD.
• A prescription for a blood thinning medication like warfarin, aspirin, clopidogrel, rivaroxaban, or dabigatran.

How is a perineal urethrostomy performed?

The procedure is performed in a hospital under general anesthesia.

There are several variations of the procedure. The Blandy technique is the most common type of perineal urethrostomy. It involves making an inverted U-shaped incision (cut) in the perineum just underneath the scrotum.

After the skin is opened, the bulbar urethra is exposed and a lengthwise incision of about three to four centimeters is made into the urethra. The top part of the perineal flap of skin is sutured (sewn) to the closest part of the opened urethra. The edges of the perineal flap are also sutured to the edges of the urethral mucosa. The scrotal skin is then sutured to the upper part of the urethral opening until it meets the perineal flap and this completes the opening.

After the surgery, a Foley catheter is placed into the bladder through the urethrostomy to drain urine out of the body.

How long does a perineal urethrostomy take?

One to two hours.

Will I be asleep during a perineal urethrostomy?

Yes, you will be under general anesthesia.

What should I expect after the procedure?

Your healthcare provider may do the following before you leave the hospital:

• Tell you how to take care of yourself at home.
• Arrange an appointment where your catheter will be removed.
• Give you any antibiotics or pain medications you may need.
• Schedule follow-up appointments.

Are there any complications associated with a perineal urethrostomy?

Complications are rare.

Symptoms that could indicate a complication include a low urinary flow rate, an increase in the amount of residual urine in the bladder after urination, or a urinary tract infection. Additional possible complications include:

• Bleeding from the incision.
• Swelling.
• Infection.
• Fever.
• Urinary tract infection.
• Residual urine in the bladder after urination.
• Low urinary flow rate.
• Recurrence of the urethral stricture or narrowing, which would require more surgery
• Cardiovascular problems.

Is a perineal urethrostomy painful?

You may experience some pain. Your healthcare provider may prescribe you a pain medication or recommend an over-the-counter pain reliever.

What happens during the recovery period?

The catheter usually stays in place for two to three weeks following surgery. During that period, the patient is given antibiotics and pain-relieving medication. If necessary, the catheter may be left in for a longer time. Routine follow-up visits are arranged, and a cystourethroscopy is often performed after about eight to 12 months to make sure that the urethra is patent and free of recurrent stricture.

After that, the urinary flow rate and amount of residual urine may be measured every six months to one year.

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

The success rate for people who go through a perineal urethrostomy has been described as “excellent.”

How should I care for myself?

Note that after the procedure, you will need to sit and lift your scrotum up to urinate.

When should I contact my healthcare provider?

Contact your healthcare provider right away if you experience any of the complications. Again, they include:

• Heavy or severe bleeding from the incision.
• Swelling.
• Infection.
• Fever.
• Urinary tract infection.
• Residual urine in the bladder after urination.
• Low urinary flow rate.
• Recurrence of the urethral stricture.
• Narrowing, which would require more surgery.
• Cardiovascular problems.