Login to Access Video or Poster Abstract: MP36-12
Sources of Funding: None

Introduction

Many of the patients at the present time undergo a one-stage repair for urethral strictures. The indications for a staged repair remain few, such as complex long segment penobulbar urethral strictures, strictures after multiple failed hypospadias repair, those associated with malignancy or radiotherapy and extensive lichen sclerosis related strictures. In the present study, we evaluate the long term voiding and sexual outcomes of permanent perineal urethrostomy and compare with the existing literature.

Methods

This study is a prospective evaluation of 116 patients who had permanent perineal urethrostomy at our institution from January 2000 to October 2015. All patients had complex or long segment anterior urethral strictures. The patients were evaluated with clinical history and examination, retrograde urethrography (RGU) and voiding cystourethrogram (VCUG). The patients were also evaluated with a self-completed nonvalidated questionnaire for their voiding and sexual function which was filled at their last visit.

Results

From January 2000 to October 2015, 212 patients underwent perineal urethrostomy either as a primary (permanent) or staged procedure. 96 patients opted for a secondary procedure for reconstruction of the urethra and were excluded. The remaining 116 patients with mean age of 58±7.3 years were analysed. Mean anterior urethral stricture length was 6.5±2.1 cm (4.0 to 12.0 cm). The etiology of the urethral stricture was unknown or multifactorial in 67/116 (57.7%) patients and Lichen sclerosus in 31/116 (26.7%) patients. The most common late postoperative complication was meatal stenosis of the urethrostomy (10.3%). The median peak flow rate on uroflowmetry after surgery was 18.5 mL/s which was significantly better than the median preoperative value (5.6mL/s) (p=0.001). 75.0% of the patients were satisfied with the overall results. Of those who were sexually active after surgery, 64.5% patients were able to have a satisfactory sexual intercourse.

Conclusions

Permanent perineal urethrostomy is an acceptable option for complex long segment anterior urethral strictures especially in elderly sexually inactive patients with excellent long term outcome. More than half of the sexually active patients also maintained satisfactory sexual health.

Funding

None