Perineal Urethrostomy After Urethral Stricture: Step-by-Step Surgical Technique

Urethral stricture is a chronic narrowing of the urethral lumen caused by inflammation and iatrogenic interventions, including previous surgery and prostate cancer treatment (1). Treatment options include urethral dilation, internal urethrotomy, urethroplasty, and perineal urethrostomy. Perineal urethrostomy creates a permanent urethral meatus and is increasingly considered a primary treatment option for complex cases or patients with significant comorbidities (2, 3). It is associated with high patient satisfaction, preserved continence, and favorable voiding outcomes (4). This video presents a systematic, step-by-step description of the surgical technique.

A 73-year-old man with complex, recurrent urethral stricture had undergone multiple reconstructive and endoscopic procedures before perineal urethrostomy in February 2026. His medical history was notable for Bowen's disease of the glans penis. Under spinal anesthesia, with the patient in the high lithotomy position, an inverted U-shaped perineal incision was made, and the bulbocavernosus muscle was dissected to expose the bulbar urethra. The perineal skin was sutured to the opened urethra, incorporating the urethral mucosal edge, corpus spongiosum adventitia, and skin edge. The dorsal urethral plate was left intact, preserving longitudinal blood flow within the corpus spongiosum. A Foley catheter was inserted through the proximal urethrotomy into the bladder.

Operative time was 60 minutes, with no intraoperative complications. The Foley catheter was removed at 14 days, with satisfactory voiding documented. At 60-day follow-up, the patient reported a satisfactory urinary stream and improved quality of life.

Perineal urethrostomy is a safe and reproducible option for complex and recurrent urethral strictures and may also be considered as a primary treatment modality.