Risk of Urinary Tract Infection with Perineal Urethrostomy Versus Urethroplasty

Area of Science:

• Urology
• Surgical Innovation
• Infectious Disease Epidemiology

Background:

• Perineal urethrostomy (PU) is a treatment for complex urethral strictures, particularly after failed urethroplasty.
• The anatomical location of the neourethral meatus after PU may theoretically increase urinary tract infection (UTI) risk.
• This study aimed to evaluate and compare UTI rates in patients undergoing PU versus urethroplasty.

Purpose of the Study:

• To investigate the incidence of urinary tract infections (UTIs) in patients who have undergone perineal urethrostomy (PU).
• To compare UTI rates between patients treated with PU and those treated with substitution or augmented urethroplasty for complex urethral strictures.
• To determine if PU poses a higher risk for recurrent UTIs (rUTIs) compared to urethroplasty.

Main Methods:

• Retrospective analysis of medical records for patients who underwent PU between 2004 and 2023.
• Comparison with a control group of patients with similar complex urethral strictures treated with urethroplasty.
• Primary endpoint: incidence of recurrent UTI (rUTI) or prophylactic UTI treatment; secondary data: chronic asymptomatic bacteriuria, UTI events, urethral dilation; statistical analysis using t tests, Wilcoxon signed-rank tests, and Fisher's exact test.

Main Results:

• The study included 67 patients in the PU group and 66 in the control urethroplasty group.
• Recurrent UTI (rUTI) incidence was 21% in both the PU and urethroplasty groups.
• No significant differences were observed in rUTI rates (21% vs. 21%), urethral dilation requirements (p=0.78), asymptomatic bacteriuria (p=0.74), or antibiotic-treated UTI events (p=0.71) between the groups.

Conclusions:

• Perineal urethrostomy (PU) does not appear to increase the risk of urinary tract infections (UTIs) when compared to urethroplasty for complex urethral strictures.
• The findings suggest that PU is a viable surgical option for complex urethral strictures without a significantly higher risk of UTIs.
• These results provide important clinical guidance for surgeons managing patients with complex urethral strictures, informing treatment choice based on infection risk.