BULBAR URETHRA: PERINEAL URETHROSTOMY

The surgical technique of “Perineal urethrostomy” is to create a new urethral opening via the perineum, just above the anus (figure 1), thus avoiding that urine need to travel through the entire length of the urethra (figure 2). Using this technique the male urethra, 12-18 cm long, becomes similar to the female urethra, 5-6 cm long. This change permits that the bladder requires a shorter tract to push out urine.
The surgical technique of Perineal urethrostomy does not interfere with urinary continence and does not require the use of external pads or catheter. The patient is requested to void in a seated position because urinary flow is through the perineal opening and no longer through the apex of the glans. This perineal opening is concealed (figure 3) and is not visible when the patient is in a standing position.
The surgical technique of Perineal urethrostomy is basically suggested in the following cases:

  • Patients with urethral strictures associated with superficial bladder tumor which requires periodical cystoscopy or endoscopic removal of the tumor. By using the perineal opening, it is easy for the urologist to perform any endoscopic procedure. For the patient, this procedure is painless.

  • Patients with urethral strictures associated with neurogenic bladder, bladder diverticula, showing high post-voiding residual urine volume. Since the urethra is shorter after the procedure, it is easier to obtain a complete emptying of the bladder.

  • Patients with urethral strictures who had undergone previous and numerous failed surgical attempts to repair urethral stricture disease, showing a high risk of stricture recurrence rate.

  • Elderly patients with urethral strictures associated with poor general health conditions in which an extended time under anesthesia in order to perform complex urethral repair is not suggested.

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figure 2
figure 3