For some men, urinating can be a very painful and uncomfortable experience. The urine flows as if it is stuck, drip by drip... sometimes it can even be completely blocked. The main reason for this can be a blockage of the urethra, that is, a narrowing. In medical terms, we call this ' Urethral Stricture '. So, today we are talking about a special surgery that doctors recommend when other treatment methods have not been successful.
What is Perineal Urethrostomy?
Simply put, a Perineal Urethrostomy is a surgical procedure performed on men. It involves creating a new opening, or passageway, for urine to pass through. This new opening is made in the area of skin between your scrotum and your anus. We call that area the 'perineum'.
Imagine, normally, urine that collects in our bladder travels down a tube called the urethra and exits at the tip of the penis. However, due to some infections, injuries , or previous surgeries, this urethra can become scarred, narrowed, or blocked. That's when the flow of urine becomes completely or partially blocked. This surgery creates a new, permanent path for urine to exit for those whose urethra is so blocked that they can't pass urine through the penis.
Why do you need to have this kind of surgery?
This surgery is often considered when other treatments for urethral stricture have failed. That is, when the urethra cannot be repositioned so that urine exits through the tip of the penis. After this surgery, urine exits through a new opening in the perineum, so you will need to sit while urinating.
This can also be a good option for older people who do not want to undergo major reconstructive surgery. This surgery is considered in the following situations.
| Conditions that may require surgery | A simple explanation |
|---|---|
| Complex/recurrent urethral strictures | Cases where the urethra remains blocked and does not respond to other treatments. |
| Squamous cell carcinoma of the penis | Due to some cancers that occur in the penis. |
| Surgical removal of the penis (Penectomy) | When the penis is completely removed due to cancer or other reasons. |
| Urethrectomy | When all or part of the urethra is surgically removed. |
| Hypospadias | This is a congenital condition in which the urethral opening is located on the underside of the penis instead of the tip. |
| Failed urethroplasty | When previous surgeries to repair the urethra were unsuccessful. |
| Fournier's gangrene | After a severe infection of the penis and scrotum. |
Who is not suitable for this surgery?
But not everyone can have this surgery. In some cases, it can be a little complicated. If you have any of these things, you should talk to your doctor about this in depth:
- If you are morbidly obese .
- If you have previously had surgery on the perineum area .
- If you have had radiation treatment for prostate cancer.
Some common questions you may have
Does semen come out of the penis after surgery?
This is a problem that many people have. No, after this surgery, semen does not come out of the penis, but from the newly created opening.
Will this surgery cause loss of urinary control?
Another big fear is that you will be incontinent. That won't happen. You have the muscles that control your urine well above this opening. So you can control your urine.
This surgery will not cause incontinence. Don't worry about that. Your doctor will explain this to you in more detail.
How to prepare for surgery?
Before the surgery, your doctor will ask you to provide a urine sample. He or she will start you on antibiotics to prevent infection. You may also need to take an X-ray to check the condition of your urethra.
The most important thing is to inform your doctor about your other illnesses and the medications you are taking.
| Be sure to tell your doctor about these things. | |
|---|---|
| Things implanted in the body | Things like stents, joint replacements, pacemakers, heart valves. |
| Infections | If you have had an infection such as MRSA. |
| Blood thinners | If you are taking medications such as warfarin, aspirin, clopidogrel, rivaroxaban, or dabigatran. |
How the surgery is done and what happens afterwards
This is done in the hospital, under general anesthesia . This means that you are completely asleep during the surgery. So you don't feel anything. The surgery usually takes one to two hours.
After surgery, a tube will be placed in your bladder to help you pass urine. We call it a Foley catheter . This catheter will usually stay in place for about two to three weeks. During this time, you will be given painkillers and antibiotics to prevent infection.
Before you leave the hospital, the doctor and nursing staff will explain to you how to take care of yourself at home, how to care for your catheter, how to take your medication, and when you need to return to the clinic.
After about 8-12 months, a test called a cystourethroscopy, which uses a camera, is performed to see if the urethra is healthy or if it has become blocked again.
What are the possible complications?
The success rate of this surgery is very high (reported as "excellent"). And complications are very rare. However, it is important to be aware of them in case something does happen.
If there is a complication, symptoms may include: decreased urination, urine remaining in the bladder after urination, or a urinary tract infection. Other possible complications include:
- Bleeding from the cut
- Swelling
- Fever
- Urinary tract infection
- Recurrence of the stricture
- Cardiovascular problems
If you experience any of these symptoms, for example, excessive bleeding from a cut or a high fever, inform your doctor immediately or go to the nearest hospital's Emergency Department (ETU) .
Take-Home Message
- Perineal Urethrostomy is a highly successful surgical procedure for severe urethral strictures where other treatments have failed.
- After this surgery, you will need to sit to urinate. Also, semen will come out of the newly created opening.
- This surgery will not cause you to lose your ability to control your urine (incontinence).
- The risk of complications is very low, but if you experience any unusual symptoms (heavy bleeding, fever), inform your doctor immediately.
- Following the doctor's instructions (taking medication, attending clinics) after surgery is essential for a speedy recovery.
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