Perineal urethrostomy helps improve outcomes in complex urethral strictures

Patients with complex anterior urethral strictures derive favourable voiding outcomes following perineal urethrostomy, with preserved continence function as well as high satisfaction, reports a study.

A team of investigators identified 76 patients who underwent perineal urethrostomy between 2009 and 2023. They conducted a comprehensive long-term follow-up and examined both objective (retreatment-free survival) and subjective outcomes using validated questionnaires.

In addition, a scoping review of all studies reporting outcomes after perineal urethrostomy was carried out to provide further context to the findings.

Of the patients, more than half (55 percent) had iatrogenic strictures, with the majority (82 percent) previously undergoing urethral interventions.

Eighty-four percent of patients achieved retreatment-free survival at a median follow-up of 55 months, with 16 percent having perineal urethrostomy recurrent stenosis.

Patient-reported outcomes showed a generally satisfactory voiding function (Urethral Stricture Surgery Patient-Reported Outcome Measure Lower Urinary Tract Symptoms score) and continence (International Consultation on Incontinence Questionnaire–Urinary Incontinence Short Form), with median scores of 4 (range 0–24) and 0 (range 0–21), respectively.

However, there were bimodal distributions of sexual function scores, with median International Index of Erectile Function–Erectile Function domain of 3.5 and median Male Sexual Health Questionnaire–Ejaculation Scale of 21.

Patients also reported “very high” treatment satisfaction, with a median Internation Consultation on Incontinence Questionnaire–Satisfaction outcome score of 21 (range 0–24).

In the scoping review, success rates varied, ranging from a low of 51 percent to as high as 95 percent. This finding stressed the difficulties in comparison due to different success definitions and patient case mix.

“It presents a viable option for older and comorbid patients, especially after thorough counselling on expected outcomes and potential risks,” the investigators said.