Perineal Urethrostomy needed to eliminate chronic UTIs

This is the surgery I had last week at the University of San Francisco Medical Center by Dr. Breyer and Dr. Sanford. Surgery went well, was released the same day. The goal of the surgery is to create a health output for urine from the bladder. I’ve had many years of difficulty completely voiding my bladder from damage caused by radiation treatments for rectal cancer in 1986.

Perineal Urethrostomy

When patients have extensive recurrent strictures of the distal urethra and desire a simple procedure to relieve the obstruction, a perineal urethrostomy is an option.

Perineal urethrostomy for treatment of a stricture of the urethra. Image

A perineal urethrostomy is an opening under the scrotum connecting the skin to the urethra. During urination, the urine exits from the urethrostomy and therefore does not have to travel through the narrow distal stricture. This is particularly appealing to older patients with multiple medical problems who desire relatively simple definitive treatment.

I had hoped to get a urethroplasty (reconstruction of the urethra, keeping my original plumbing) using tissue from the inside of my mouth to bridge the gap where the damaged urethra was removed, but because the damaged urethra was nearly 2 inches in length, the chance of success was reduced. A two step operation (described below) to position me for a second surgery in the coming months was an option, utilizing the Perineal uresthrostomy as an interim (possibly permanent) solution. However, due to the poor tissue quality caused by radiation treatments for colon cancer in 1986, the likely hood of complications was high. So I chose the simplest surgery that would result in the best chance for a favorable outcome with the least possibility of complication.

So I have to sit down to urinate…so what! It’s what my wife taught me to do to keep the toilet clean anyway!

Urethroplasty (what I had hoped to get, but didn’t)

The open reconstruction of urethral stricture disease, also called urethroplasty, may involve surgery to remove the involved segment and re-attach the two normal ends. This is called excision and primary anastomosis. This procedure is best suited for short strictures involving the bulbar or membranous urethra in particular. When this repair is not possible, tissue can be transferred to augment and therefore widen the narrow segment to a normal caliber. For example, the urethra can be augmented using penile skin. Other tissues that can be used to reconstruct the urethra include a graft of buccal mucosa (skin inside the cheek). When the above procedures are not an option, alternatives include a two-stage repair where a buccal mucosa and/or a split-thickness skin graft is placed along the undersurface of the penis, and later rolled into a new urethra (neo-urethra). The choice of repair is individual and influenced by the length and location of the stricture, the availability of local tissue, and other factors.

Comment by Randy Henniger 11/1/13

Got the cath out yesterday and couldn’t urinate. After 6 hours went to ER, and finally was able to urinate at about 9 hours. What a relief. Now urinating on my own with no cath for the first time in months. Still have a lot of work to do on control and completely voiding my bladder to eleminate risk of UTIs.… 11/25/13

Met with Dr. Breyer. He and I were both disappointed that the surgery has not yielded the results we’d hoped for. Doctor suggested a urostomy, if conditions don’t improve within 2 month. Sigh…

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