REDO Perineal Urethrostomy

M. Costa-Grau, P. M. Joshi

perineal urethrostomy, redo case

We would like to present a case of a REDO perineal urethrostomy. Perineal urethrostomies can be part of a multistage program or a permanent solution, boasting a high satisfaction rate between 82-94% and a re-stricture rate of 10-23%.

In this video, we demonstrate a REDO perineal urethrostomy on a 48-year-old patient with a history of hypospadias. He underwent a first-stage urethroplasty three years ago and chose to maintain the perineal urethrostomy. He now presents with a bulbar stricture.

The procedure begins with the creation of a wide U-shaped perineal flap using well-vascularized ample tissue. Next, urethral dissection and urethrotomy are performed up to the proximal bulbar urethra. It is crucial to perform muco-spongiosum running sutures to prevent bleeding. The most critical part of the procedure is the anastomosis of the proximal urethra to the flap skin, using three interrupted sutures of Vicryl 4-0. Muco-cutaneous sutures are then placed, followed by the final step of skin closure.

1. Shinchi, M., Horiguch, A., Ojima, K. et al. Evaluation of the efficacy of perineal urethrostomy for patients with anterior urethral stricture: insights from surgical and patient-reported outcomes. World J Urol 39, 4443–4448 (2021). https://doi.org/10.1007/s00345-021-03795-2

2. Rahav NJ, Udah M, Cohen S, Bdolah-Abram T, Chertin B, Shenfeld OZ. Proximal Urethrostomy Versus Urethroplasty for Complex Urethral Strictures. Eur Urol Open Sci. 2024 Mar 6;62:91-98. doi: 10.1016/j.euros.2024.02.008. PMID: 38486615; PMCID: PMC10937552.