title: The outcomes of perineal urethrostomy with preservation of the dorsal urethral plate and urethral blood supply.
abstract: OBJECTIVE
  To describe the surgical technique and outcomes for perineal urethrostomy. We sought to identify factors that predicted surgery failure within our patient cohort and to describe key aspects of the operation aimed at preservation of the dorsal urethral plate and longitudinal blood supply within the urethra.
  
  
  METHODS
  We reviewed our prospectively collected database and identified 45 men who underwent definitive perineal urethrostomy from 1989 to 2009. Primary success was defined as no need for additional treatment. If 1 urethral dilation was performed, outcome was defined as a secondary success. Statistical analyses were performed to determine variables associated with failure.
  
  
  RESULTS
  Urethral pathology was varied and included idiopathic strictures (20%), lichen sclerosis (20%), infection (16%), radiation for prostate cancer (13%), prior hypospadias repair (11%), instrumentation or catheter trauma (11%), and penile cancer or condyloma (9%). Of these men, 21 (48%) had prior urethroplasty. Forty patients had follow-up greater than 3 months (median, 31 months). Postoperative stenosis occurred in 7 (18%) patients. Previous radiation therapy was a significant risk factor for postoperative stenosis on univariate (OR 12.4, 95% CI 1.8-84.3, P <.01) and multivariate analysis (OR 11.2, 95% CI 1.4-87.2, P <.02). Primary success rate for perineal urethrostomy was 83% (33/40 patients) and secondary success rate was 93% (37/40).
  
  
  CONCLUSIONS
  During creation of perineal urethrostomy, when the longitudinal blood supply within the bulbar urethra is preserved rather than transected, stenosis of the perineal urethrostomy is a rare complication primarily in patients who have a history of radiation therapy.
authors.affiliation: Department of Urology, The University of California, San Francisco, San Francisco, CA, USA.
authors.forename: Jeremy B
authors.initials: JB
authors.lastname: Myers
authors.forename: Sima P
authors.initials: SP
authors.lastname: Porten
authors.forename: Jack W
authors.initials: JW
authors.lastname: McAninch
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006801:Humans; D008297:Male; D008875:Middle Aged; D010030:Ostomy / Q000379:methods*; D010502:Perineum; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D016896:Treatment Outcome; D014521:Urethra / Q000098:blood supply* / Q000601:surgery*; D014522:Urethral Diseases / Q000601:surgery*; D013521:Urologic Surgical Procedures, Male / Q000379:methods; D055815:Young Adult