1.What is Perineal Urethrostomy (P.U.)?
It is a creation of a new urethral opening in the perineum for the passage of urine. Perineum is the space between the scrotum and the anus.
2.How will I pass urine after this surgery?
You must sit to void because urine flows through the perineal opening.
3.Is it permanent or temporary?
In temporary type, this operation is part of staged procedure. During 1st stage P.U. is performed and in 2nd stage urethral continuity will be re-established after 3 to 6 months. So the opening in the perineum would be closed.Whereas in permanent type, as the word says there is no plan to re-establish the continuity in the future.
4.When is this P.U. advised?
It is usually indicated in urethral strictures in elderly patients
- with associated bladder tumor which requires regular endoscopic procedures
- who had undergone numerous failed surgical attempts at repair
- along with many medical illnesses and poor general health
5.What kind of anesthesia is required for this procedure?
Usually this procedure is done under spinal or epidural anesthesia. This would be any how decided by anaesthetist after examining you. Sometimes general anesthesia would be required if we need to use a graft from buccal mucosa.
6.How much time does this surgery take?
About 2 to 3 hours.
7.What about erection and urinary incontinence after the surgery?
If you were having erections before surgery, you should continue to have erections after surgery. However the semen would come out from the perineal opening. There is no risk of incontinence of urine as this opening is made beyond the muscles which control urine.
8.How many days I need to stay in the hospital?
Usually about 2 to 3 days.
9.How long will I have the catheter after the surgery?
The urethral catheter would be removed after 7 to 10 days.
10.Are there any instructions after I am discharged?
You can have your normal diet. You may be advised simple analgesics and laxatives until the catheter is removed. You can walk within the house and avoid travelling. You will be explained how to care of the catheter and the perineal wound care by the urology nurse before leaving the hospital.
11.When will I be able to join work?
If your work does not involve physical exertion, you should be able to join work in 2 weeks from surgery. If it involves physical exertion, you can join work after 1 month after surgery.
12.When can I resume sexual and sports activities?
Sexual and sports activities can be gradually resumed about 1 month after the removal of the catheter.
13.Can I drive bike or car immediately after the surgery?
Not until 3-4 weeks after surgery.
14.What are the possible post-operative complications?
This procedure can cause urinary, sexual and psychological problems in few. So you need to understand the prons and cons of this operation fully before this surgery. Some of these points have already been discussed above.You may develop scrotal swelling in which case your doctor will tell you how to apply scrotal support. This will subside in a few weeks. The urethral opening may narrow in upto 30 % of the cases and may require revision procedure or dilatation to keep it open.
Guido Barbagli et al. J. Urol 182, 548-557, August 2009
Campbell Walsh Urology 10th Edition Chapter 36.