The surgical technique of “Perineal urethrostomy” is to create a new urethral opening via the perineum thus avoiding that urine need to travel through the entire length of the urethra.
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 tip of the penis. This perineal opening is concealed and is not visible when the patient is in a standing position.Thus it will not alter the body image of the patient.
It is very effective method of making the patient catheter free in cases of recurrent stricture anterior urethra( multiple failed surgeries, patients with comorbidities who are not suitable for long reconstructive surgery).
We performed this surgery recently for a patient of chronic renal failure .He had a long segment anterior urethral stricture.He was frail and was kept on indwelling SPC( suprapubic catheter).We evaluated him with endoscopy and MCUG which revealed prximal bulb was spared.So he was an ideal case for perineal urethrostomy.
He was thoroughly counseled.
There are some common apprehensions in the minds of the patients like:
1) The patient has to pass urine in sitting position so they feel embarrassed They need counselling in this regards.Explaining the meed for making them catheter free and retention free.Pros weigh more than cons here.Little bit of modification of life style in a way avoiding public toilets would give them psychological advantage.
2)They think that they will become incontinent.Continence depends upon the sphincter which is spared in the surgery so in no way they have to fear about incontinence and use of diapers /pads.
Using this technique the male urethra, 12-
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 tip of the penis. This perineal opening is concealed and is not visible when the patient is in a standing position.Thus it will not alter the body image of the patient.
It is very effective method of making the patient catheter free in cases of recurrent stricture anterior urethra( multiple failed surgeries, patients with comorbidities who are not suitable for long reconstructive surgery).
We performed this surgery recently for a patient of chronic renal failure .He had a long segment anterior urethral stricture.He was frail and was kept on indwelling SPC( suprapubic catheter).We evaluated him with endoscopy and MCUG which revealed prximal bulb was spared.So he was an ideal case for perineal urethrostomy.
He was thoroughly counseled.
1) The patient has to pass urine in sitting position so they feel embarrassed They need counselling in this regards.Explaining the meed for making them catheter free and retention free.Pros weigh more than cons here.Little bit of modification of life style in a way avoiding public toilets would give them psychological advantage.
2)They think that they will become incontinent.Continence depends upon the sphincter which is spared in the surgery so in no way they have to fear about incontinence and use of diapers /pads.
Thanks for sharing the report on Perineal urethrostomy . treatment of perineal is very essential as most of the people face the urine problem.
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