Perineal urethrostomy: A single-stage viable option for complex anterior urethral strictures

Perineal urethrostomy (PU) is a valid single stage option with maximum success to manage complex anterior urethral strictures.

To evaluate the functional outcome of permanent PU using the Blandy technique in older patients or PU with staged reconstruction in young patients with severely diseased distal urethra.

This is a retrospective analysis of 124 patients. They underwent Blandy's PU with or without Johanson stage 1. Exclusion criteria included patients with posterior urethral strictures or bladder neck contractures.

Mean age of patients was 54 years. Strictures due to catheterisation or instrumentation were most common - 85 (68.54%). Out of 124 patients, 71(57.3%) of them were posted for PU with Johanson stage 1 and 53 for PU only (42.7%) according to patients' choice. In patients age below 50 years, PU (N=10), PU with Johanson stage 1 (N=40) and Johanson stage 2 (N= 8) patients had mean Qmax of 20.2ml/s (17-24), 20.7ml/s (16-26), 16.375ml/s (14-18) respectively. In patients age> 50 years, PU (N=43), PU with Johanson stage 1 (N=31) and Johanson stage 2 (N= 4) patients had mean Qmax of 16.41ml/s (11-24), 17.25ml/s (11-25) and14.75 ml/s (12-17) respectively.For patients with only PU, 8/53 patients (15.09%) required secondary intervention (stomal dilatation N=6 and TURP N=2) while in PU with Johanson stage 1 patients, 10/71(14.08%) required secondary intervention (Stomal dilatation N=6, 8.45% and TURP N= 4, 5.6%). 112/124 (90.32%) were considered successful.

Since most of patients have suffered for years, PU provides results in one stage.