Perineal Urethrostomy Formation is a reconstructive procedure that creates a permanent urethral opening in the perineum to divert the urinary stream away from the native urethral channel. It is typically performed in patients with complex, recurrent, or pan-urethral strictures that are not amenable to conventional urethroplasty, or in those with prior failed reconstructive attempts.
The procedure involves surgically bringing a flap of perineo-scrotal skin to the healthy bulbar urethra to form a wide, stable, and low-pressure urinary outlet in the perineum. This enables reliable voiding without the need for urethral instrumentation or long-term catheterisation.
Perineal urethrostomy may be considered a definitive solution in patients with extensive urethral disease, lichen sclerosus, or significant comorbidities that preclude further reconstruction. It may also be used as part of a staged approach in complex urethral reconstruction.
As with all urethral reconstructive procedures, it requires specialist expertise. Post-operative care includes perineal wound management and monitoring for stenosis at the new perineal meatus. Long-term outcomes are generally favourable, with high patient satisfaction when the procedure is well-selected and technically successful.
