Name of the Procedure:

Urethrotomy or Urethrostomy, External (Separate Procedure); Perineal Urethra, External

Summary

This procedure, known as a perineal urethrostomy, involves creating an opening in the perineal area to aid urinary flow by bypassing a blocked or damaged section of the urethra. It is usually performed as an external and separate procedure targeting the perineal urethra.

Purpose

A perineal urethrostomy is performed to alleviate urinary blockage or obstruction typically caused by conditions like urethral stricture or trauma. The goal is to restore normal urinary flow and improve the patient’s quality of life.

Indications

• Chronic urethral stricture disease
• Failed previous attempts to treat urethral strictures
• Severe trauma to the urethra
• Conditions causing recurrent urinary tract infections due to obstruction

Preparation

• Patients are usually required to fast for several hours before the procedure.
• Certain medications may need to be adjusted or temporarily discontinued.
• Pre-procedure assessments may include urine tests, blood tests, and imaging studies like ultrasound or retrograde urethrogram to evaluate the urethral condition.

Procedure Description

1. The patient is placed under general anesthesia.
2. The perineal region is cleaned and sterilized.
3. An incision is made in the perineal area (between the scrotum and anus).
4. The surgeon identifies the urethra, carefully dissects to the area of interest, and creates an external opening.
5. Stitches may be applied to secure the opening and ensure it remains patent.
6. A catheter may be placed temporarily to support healing and ensure urine flow.

Duration

The procedure typically takes about 1 to 2 hours, depending on the complexity of the case.

Setting

The procedure is performed in a hospital's operating room or an outpatient surgical center.

Personnel

• Urologic surgeon
• Surgical nurses
• Anesthesiologist
• Operating room technicians

Risks and Complications

• Infection
• Bleeding
• Scarring or recurrent strictures
• Urinary incontinence
• Pain or discomfort at the surgical site
• Fistula formation (abnormal connection between organs)
• Possible need for additional surgeries

Benefits

• Relief from urinary obstruction and improved urinary flow
• Decreased risk of recurrent urinary tract infections
• Improved bladder function
• Enhanced quality of life soon after recovery

Recovery

• Patients may expect to stay in the hospital for a day or two for monitoring.
• Pain management will be provided with medications.
• Instructions include keeping the area clean, monitoring urinary output, and avoiding strenuous activities.
• A follow-up appointment is usually scheduled within a few weeks to ensure proper healing.
• Most patients return to normal activities within 4 to 6 weeks.

Alternatives

• Urethral dilation: Benefits include a less invasive approach but higher recurrence rates.
• Urethral stenting: Minimally invasive but may require repeat procedures.
• Internal urethrotomy: Suitable for short strictures but also has recurrence risks.
• Perineal urethrostomy offers a more permanent solution but is more invasive.

Patient Experience

During the procedure, the patient will be under general anesthesia and feel no pain. Post-procedure, patients may experience discomfort or pain at the surgical site, which can be managed with prescribed pain relief medications. There may be a temporary need for catheterization. Recovery involves gradual improvement in urinary function and adherence to post-operative care instructions for optimal healing.