Role of Perineal Urethrostomy in Reconstructive Urology

Perineal urethrostomy (PU) involves the creation of a urethral meatus at the perineal level. Traditionally, it was regarded as a last-resort therapeutic option or the outcome of failed previous reconstructive attempts. Currently, this perspective has evolved, and PU is increasingly considered a primary indication in complex cases or in patients with significant comorbidities. PU can be performed either as a definitive procedure—in patients with extensive, recurrent strictures or in those with comorbidities that preclude formal reconstruction—or as a temporary measure to facilitate healing and optimize conditions prior to definitive reconstructive surgery. In oncologic cases associated with total penectomy, PU serves as the definitive form of urinary diversion, and the same reconstructive principles should be applied to its design. A key requirement for PU is preserved sphincteric continence and the absence of proximal urethral stenosis. Advances in surgical techniques, including the use of flap mobilization and grafting, have enabled the creation of wide, functional meatuses, reducing the rate of stricture recurrence. Additionally, non-transecting variants aim to preserve the vascularization of the dorsal urethral surface. Following these surgical principles, high success rates can be achieved. Despite representing a significant alteration of anatomy and voiding habits, patient satisfaction is generally high. PU should not be viewed merely as a palliative alternative but rather as a versatile reconstructive option capable of providing comfortable and durable voiding in selected patients. Appropriate patient selection and meticulous surgical execution remain essential pillars of contemporary urethral surgery.