Risk of Urinary Tract Infection with Perineal Urethrostomy Versus Urethroplasty

Perineal urethrostomy (PU) is performed for urethral strictures in patients with high risk and those with complex strictures, such as after failure of urethroplasty. After PU, the neourethral meatus is located in the perineum in proximity to the anus, which may theoretically increase the risk of urinary tract infection (UTI). Our aim was to examine UTI rates among PU patients.

Medical records for PU patients between 2004 and 2023 were analyzed for UTI incidence. A control group comprised patients with similar complex urethral strictures who underwent substitution or augmented urethroplasty. The primary endpoint was the incidence of recurrent UTI (rUTI), defined according to the European Association of Urology guidelines, or the use of prophylactic treatment for UTI. Data for chronic asymptomatic bacteriuria, UTI events, and urethral dilation were recorded. Analyses included t tests and Wilcoxon signed-rank tests for continuous variables, and Fisher's exact test for categorical variables.

There were 67 patients in the PU group and 66 in the control group, with median age of 51 yr (interquartile range 39-61) and 42 yr (interquartile range 29-58), respectively. Follow up was 32 mo for the PU group and 76 mo for the control group. The rUTI incidence rate was 21% in both groups. Repeat urethral dilation was required in five patients in the PU group and six in the control group (p = 0.78). Asymptomatic bacteriuria was observed in four patients in the PU group and six in the control group (p = 0.74). Overall, 21 patients in the PU group and 24 in the control group experienced a UTI event treated with antibiotics (p = 0.71).

PU does not increase the risk of UTI in comparison to urethroplasty for complex urethral strictures.

We looked at the rate of urinary tract infection after two different surgical treatments (called perineal urethrostomy [PU] and urethroplasty [UTP]) for complex urethral stricture in men, which is a narrowing of the tube draining urine from the bladder. Infection rates did not differ between the PU and UTP techniques, but were higher than in the general population. When choosing between treatment options for this condition, the PU technique does not have higher risk of urinary tract infection than UTP.