Urethroplasty: Perineal urethrostomy for severe urethral strictures

Section Editor’s note: ‘Y’tube, a new video section of UrologyTimes.com, is a resource for urologists and other clinicians who focus on men’s health. ‘Y’tube covers surgical aspects of a variety of men’s health issues with the ultimate goal of accumulating a library of videos to serve as a reference. Here, three reconstructive urologists fellowship trained by Jack McAninch, MD, or Hunter Wessells, MD, illustrate the nuances of managing urethral stricture disease. Perhaps the most important aspects of these videos for the general urologist are the keys of precise setup, retraction, and exposure that facilitate meticulous tissue handling and precise suture placement. These videos serve as a reference that can be quickly reviewed before undertaking any of these procedures.

In this video, we demonstrate creation of a definitive perineal urethrostomy for management of severe urethral strictures. Patients with failed prior urethroplasties, lichen sclerosus, panurethral strictures, and older men may prefer perineal urethrostomy over urethroplasty. Other scenarios where the technique can be very useful are the treatment of patients after penectomy, partial urethrectomy, and in some cases of Fournier’s gangrene management.

Key elements we tried to address in the video are the inverted “U” advancement flap and a longitudinal urethrotomy that preserves blood flow within the dorsal urethra.

Dr. Hotaling: Although many urologists can perform a perineal urethrostomy, the technique described by Dr. Myers yields a reliable anastomosis that, due to the use of the advancement flap, has a significantly lower rate of stricture. Further, he illustrates the importance of maintaining a plane exactly in the midline of the urethra in order to allow for a precise urethrostomy. The closure technique also ensures that the flap will help to maintain patency of the urethral anastomosis.

More urethroplasty videos

Bulbospongiosus sparing dorsal onlay bulbar urethroplasty

Excision and primary anastomosis anterior urethroplasty

Posterior urethroplasty for pelvic fracture urethral injury

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