Perineal Urethrostomy

Published Date: 20th September 2024

Publication Authors: Pina. IM, Floyd Jr. MS

Introduction
Perineal urethrostomy represents an excellent option for patients with pan urethral stricture disease who are unfit for major reconstruction.

Methods
With the scrotum sewn up, the base and ischial tuberosities are marked. Methylene blue is injected and massaged down the urethra. An inverted U-shaped incision is made along the perineal raphe incorporating 2 lateral flaps. Care is taken to ensure that the apical flap is well vascularised. Bulbospongiosus is divided ensuring a waistcoat of muscle and a ring retractor inserted permitting maximum urethral exposure. With a mean arterial pressure of 55, the urethra is clamped with Babcock’s forceps and incised in the midline until the lumen is visible. Two stay sutures are inserted. The midline incision is developed distally and proximally along the ventral aspect of the urethra with scissors to ensure a urethrostomy of 5 cm. Flexible cystoscopy is performed to assess the stricture, external sphincter and bladder. An 18 fr catheter is passed to gauge patency proximally. The apical flap is sutured directly into the urethral edge with 3’0 vicryl. The distal end is approximated and lateral flaps are then closed incorporating skin, adventitia and urethral edge in an interrupted fashion. The remainder of the urethrostomy is closed and the lateral flap edges closed continuously with 5’0 Monocryl. An 18 fr catheter with bactigras is inserted and the catheter taped to the abdomen.

Results
After 2 weeks the patient returns for a TWOC.

Conclusions
The patient is assessed at 3 months with repeat symptom scores.

Pina, IM; Floyd JR, MS. (2024). Perineal Urethrostomy. European Urology Open Science. 67(Supplement 2), pp.S46-S47. [Online]. Available at: https://dx.doi.org/10.1016/j.euros.2024.07.101 [Accessed 2 October 2024].

 

« Back