Perineal urethrostomy: surgical and functional evaluation of two techniques.

Introduction: PU is an option to manage complex and/or recurrent urethral strictures and is necessary after urethrectomy and/or penectomy. PU is generally assumed to be the last option before abandoning the urethral outlet.

Method: Between 2001 and 2013, 51 patients underwent PU. Mean age (± standard deviation) was 60 ± 15 years. Only 13 patients (25.5%) did not undergo previous urethral interventions. PU was performed according to the Johanson (n = 35) or Blandy (n = 16) technique and these 2 groups were compared for surgical failure, maximum urinary flow (Qmax), urinary symptoms, and quality of life (according to the International Prostate Symptom Score).

Results: Both groups were similar for patient's and stricture characteristics. Only follow-up duration was significantly longer after Johanson PU (47.9 months versus 11.1 months; P = 0.003). For the entire cohort, 11 patients (21.6%) were considered a failure (9 or 25.7% for Johanson group and 2 or 12.5% for Blandy group; P = 0.248). There was a significant improvement of Qmax in both groups. Quality of life after PU was comparable in both groups.

Conclusions: PU is associated with a 21.6% recurrence rate and the patient should be informed about this risk.