What Is Perineal Urethrostomy?
Perineal urethrostomy is a surgical technique done on men to establish an irreversible opening into the urethra through a perineal incision. The skin between the scrotum and the anus is known as the perineum. The urethra is the tube-like structure through which urine exits the body from the bladder via the penis. During urination, urine held in the bladder typically goes through the urethra and pours out of the orifice at the end of the penis. Scarring of the urethra may occur due to infection, injury, or prior surgery. This can cause a constriction of the urethra, known as urethral stricture. It might cause the flow of urine to become partially or completely blocked.
How Is Perineal Urethrostomy Performed?
Under general anesthesia, the surgery is carried out in a hospital. The method has various versions. The Blandy procedure is the most often used perineal urethrostomy technique. Making an inverted U-shaped incision (cut) in the perineum right behind the scrotum is required. The bulbar urethra is exposed when the skin is opened, and a three to four-centimeter longitudinal incision is made into the urethra. Suture (stitch) the upper section of the perineal flap of skin to the nearest part of the opening urethra. The perineal flap's borders are likewise sutured to the urethral mucosa's edges. The patient must give a urine sample for analysis before surgery. To avoid urinary tract infections, patients are given broad-spectrum antibiotics before surgery. Before surgery, X-rays of the urethra are generally taken to assess its health.
Inform the doctor if one develops any of the following symptoms:
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An example of an implant is a stent, pacemaker, joint replacement, heart valve, or blood vascular transplant.
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Infection with MRSA (Methicillin-resistant Staphylococcus aureus).
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There is a high risk of CJD variants.
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A blood thinner prescription, such as Warfarin, Aspirin, Clopidogrel, Rivaroxaban, or Dabigatran.
What Are the Indications and Contraindications for Perineal Urethrostomy?
The method may also be an option for elderly men with anterior urethral strictures who do not want to undergo significant urethral reconstruction surgery.
Several situations may necessitate a perineal urethrostomy:
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Urethral strictures are complex and recurring.
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Penis squamous cell carcinoma (cancer).
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The surgical removal of the penis.
Urethrectomy: Surgical removal of a portion or the entire urethra.
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Hypospadias is a congenital abnormality in which the entrance of the penis (penile meatus) lies on the bottom rather than the tip of the penis.
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Previous reconstructive surgeries, such as urethroplasty, had failed.
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Fournier's gangrene of the penis and scrotum was surgically resected.
Some instances are more difficult to resolve than others. If one has any of the following conditions, they may not be a suitable candidate for a perineal urethrostomy:
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They are severely fat.
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Those who had previous perineal surgery.
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Had radiation treatment for prostate cancer.
What Are the Complications of Perineal Urethrostomy?
Complications are uncommon. A poor urinary flow rate, an increase in the volume of leftover urine in the bladder after urination, or a urinary tract infection are all symptoms of a problem.
Other potential issues include:
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Bleeding due to incision.
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Swelling.
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Urine that remains in the bladder after urinating.
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The urinary flow rate is low.
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Infection.
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Fever.
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Infection of the urinary tract.
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Recurrence of the urethral stricture or narrowing, necessitating further surgery
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Cardiovascular issues.
How Much Time Does it Take to Recover?
After surgery, the catheter is often left in place for two to three weeks. Antibiotics and painkillers are administered to the patient at that time. The catheter may be kept in for a longer period if necessary. After around eight to twelve months, routine follow-up appointments are scheduled, and a cystourethroscopy is frequently carried out to ensure that the urethra is patent and devoid of recurring strictures. Following that, measurements of the urine flow rate and residual urine volume may be taken for six months to a year.
What Is the Risk of Hospital-Acquired Infection?
A person has a four to six percent chance of contracting an infection in the hospital, including MRSA or a Clostridium difficile bowel infection. If a patient falls into one of the "high-risk" patient categories, which includes those who have had repeated hospital admissions, protracted hospital stays, bladder removal, or long-term drainage tubes (such as catheters), this number is greater.
Conclusion
When all other options for urethral reconstruction have been exhausted, perineal urethrostomy has historically been regarded as a last-resort procedure. In many cases, all reconstructive options were tried before a perineal urethrostomy was performed. Perineal urethrostomies are being performed increasingly frequently in place of sophisticated urethroplasties as reconstructive urologic surgery advances and our understanding of urethral healing and what heals and what does not grow.
