Perineal urethrostomy has been considered a last resort operation when other means of urethral reconstruction have failed. Often, these reconstructive means were indeed exhausted before moving to a perineal urethrostomy. As the field of reconstructive urologic surgery continues to develop and with it the understanding of urethral healing and what will heal and what will not, perineal urethrostomies are performed with increasing frequency and also more often instead of complex urethroplasties.
There are several surgical approaches to perineal urethrostomy and each has its own advantages and drawbacks. But this selection also means that for the vast majority of patients and patient presentations an optimal option exists. The overall outcomes of perineal urethrostomy are very good with the most frequently encountered complication being stenosis of the neo-meatus. Maneuvers ranging from simple dilation to interposition of buccal grafts can address this.
Hesitation to offering a perineal urethrostomy to a patient is often founded on the false belief that the satisfaction in regards to urination (necessity to sit down) and sexual performance is low. Indeed, recent reports delineate that the data that patient satisfaction is very high and that patients would prefer this options to a complex anterior urethral reconstruction with the associated morbidity and its challenging results. These reports will likely also increase the acceptance of perineal urethrostomy by urologists.
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We would like to thank Dr. Jessica DeLong and Dr. Allen Morey for giving us permission to use their clinical photos and diagrams in this article.
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