Shall we talk about Perineal Urethrostomy surgery?

Do you or someone you know have difficulty urinating, pain, or a slow flow of urine? Sometimes the cause of this is a narrowing or blockage of the tube that carries urine out of the penis (we call this the urethra) for some reason. In such cases, if other treatments are not successful, there is a special surgery that doctors recommend. That surgery, namely 'Perineal Urethrostomy', is what we are going to talk about in this article today.

Simply put, what is Perineal Urethrostomy?

This name may sound a bit complicated, but let's keep it simple.

Perineal Urethrostomy is a surgical procedure performed only on men. It involves creating a new, permanent opening for urine to pass through. This opening is made in the area of ​​skin between your scrotum and your anus. In medical terms, this area is called the 'perineum'.

Imagine, normally our urine comes out of the bladder through a tube that goes through the penis. We call this tube the urethra. But due to an infection, an accident, or a previous surgery, this urethra can become scarred and narrow. We call this condition Urethral Stricture . Then the passage of urine can be completely blocked or it can be very difficult to pass.

It is at times like this that, because it is difficult to pass urine through the penis, a new opening is created in the perineum area to allow urine to pass through.

Who needs this surgery?

This is not a surgery for everyone. It is especially recommended as an option for patients who have failed other treatments for urethral stricture, such as surgery to restore the urethra. Simply put, this surgery is considered if the urethra is damaged to the point where it is impossible to pass urine through the tip of the penis.

Also, this may be a good option for some older men, who are reluctant to undergo major reconstructive surgery.

Let's look at the table below to see what are the main cases in which this surgery is considered.

Who may be unsuitable for this surgery?

In some cases, this surgery can be a bit challenging. If you have any of the following conditions, this surgery may not be a good option for you. You should discuss this with your doctor before making a final decision.

• If you are morbidly obese: Being morbidly obese can make it difficult to reach the surgical site and may take longer for the wound to heal after surgery.
• If you have previously had surgery on the perineum area: If you have previously had surgery in that area, re-surgery may be complicated due to scar tissue.
• If you have had radiation therapy for prostate cancer: Radiation therapy may have damaged tissue in that area, which may interfere with the healing process after surgery.

Some common questions you may have

It's normal for a lot of questions to come to your mind when discussing this type of surgery. Let's answer some of them.

Does semen come out of the penis?

No. After this surgery, like urine, semen (ejaculation) comes out through the newly created opening . It does not come out through the penis.

Will this surgery cause urinary incontinence?

This is a big fear for many people. But the answer is "no." The muscles that help you control your urination are located well above this newly created opening. So, you can control when you want to urinate. This surgery will not affect that ability.

How do you prepare before surgery?

Before the surgery, the doctor will order several tests for you.

• A urine sample is tested to see if there is any infection.
• Antibiotics are given before surgery to prevent urinary tract infections.
• An X-ray examination is often performed to accurately assess the condition of the urinary tract.

• If you have any implants in your body (e.g. stent, heart valve, artificial joint, pacemaker).
• If you have had a specific bacterial infection like MRSA.
• If you are at high risk for variant-CJD (a very rare neurological condition).
• If you are taking blood-thinning medications (e.g. warfarin, aspirin, clopidogrel, rivaroxaban, dabigatran). These may need to be stopped temporarily before surgery.

How is the surgery performed?

This surgery is done in a hospital, under general anesthesia. This means you won't feel any pain, you'll be asleep.

Although there are various methods for performing this surgery, the most commonly used is the 'Blandy technique'. Here's what happens:

1. An incision is made in the skin of the perineum area, below the scrotum, in the shape of an upside-down 'U'.

2. Then, the urethra is exposed through the underlying tissue.

3. The urethra is opened by cutting about 3-4 centimeters lengthwise.

4. Then, the edges of the skin incision are connected to the edges of the opened urethra and sewn together with fine threads.

5. This is how a new, permanent opening is created for urine to exit.

At the end of the surgery, a tube called a 'Foley catheter' is inserted through this new opening to allow urine to flow out of the bladder.

How long does the surgery take?

It usually takes about an hour or two .

Will I be anesthetized?

Yes, you will be fully anesthetized. You will not feel anything during the surgery.

What to expect after surgery?

Before you go home from the hospital, the medical team will explain the following to you:

• How to care for the wound and how to take care of yourself when you get home.
• The date you need to come back to have the catheter removed.
• You need antibiotics and painkillers.
• Follow-up appointments are the days when you need to see the doctor again.

Are there any complications that may arise from the surgery?

Complications after this surgery are very rare . However, as with any surgery, there are some minor risks. If a complication does occur, symptoms may include a decrease in the speed of urination, urine remaining in the bladder after urination, or a urinary tract infection.

About pain and healing time

Is this painful?

It is normal to experience some pain after surgery, but it can be managed. Your doctor will prescribe painkillers for you.

What happens during recovery?

• The initial catheter usually needs to be left in for about two to three weeks, sometimes longer.
• During this time, you will be given antibiotics and painkillers.
• After the catheter is removed, the doctor will bring you to the clinic regularly for checkups.
• After about 8-12 months, a test using a camera called Cystourethroscopy can be performed to see if the newly created urethra is working well and if there has been a recurrence of the blockage.

How are the results and how should I take care of myself?

The success rate of this surgery is very high (considered "excellent"). Most patients live a good quality of life after this surgery.

The biggest change you can make is the way you urinate.

When should I see the doctor soon?

If you experience any of the following symptoms, call your doctor immediately or seek treatment.

• Excessive bleeding from the cut.
• Abnormal swelling.
• Fever or signs of infection (pus discharge, excessive redness).
• Urinary tract inflammation or other signs of a urinary tract infection.
• If you feel like your bladder hasn't emptied after urinating.
• If the urine flow rate is very slow.
• If you feel like you're having trouble urinating again.

If you have any further questions about this, don't be afraid to talk to your doctor and resolve them.