Long-term outcomes of perineal urethrostomy: a literature review

Surgical options for the treatment of anterior urethral strictures are extremely diverse and include both endoscopic procedures and various methods of urethroplasty. Urethroplasty is considered the optimal treatment option for urethral strictures, as it involves radical excision of scar tissue with restoration of adequate lumen and patency of the urethra. However, it is important to understand that in case of complex strictures (extended, recurrent, multifocal) one-stage urethral reconstruction cannot always be successfully applied. In such clinical situations, the best treatment method appears to be perineal urethrostomy, which can be applied as a final treatment option or as part of a step-by-step treatment [1,2]. In addition, in case of comorbidity of patients, this treatment option can be chosen as a priority method of urine diversion. The above circumstances determine the relevance of the present study, aimed at analyzing the effectiveness of perineal urethrostomy [3-10].

Materials and methods
The review was conducted based on data published in the PubMed and Russian Science Citation Index databases. The search in the databases was conducted using the following keywords: “urethrostomy” or “perineal urethrostomy” or “perineostomy” or “urethroperineostomy”. There were no restrictions on the years of publication. The inclusion criterion was a study reporting the results of perineal urethrostomy in 10 or more patients with urethral stricture with an average follow-up period of at least 12 months. Exclusion criteria: studies using perineal urethrostomy for urethral stricture without presenting the results of this operation; duplicate publications; works of a non-original nature (reviews, lectures, letters to the editor, etc.); the use of perineal urethrostomy for another disease (not urethral stricture). At the first stage, 175 sources were found that were related to the topic of the review. Following this, 23 studies were selected for inclusion in the review based on the criteria used [10-23].

Results
A total of 23 studies were identified that met the above criteria. These studies mostly included small patient samples. Only 4 studies included more than 100 patients who underwent perineal urethrostomy, 7 studies included between 51 and 85 patients, and the rest included fewer than 50 patients. The postoperative follow-up period was long enough, averaging 14 to 63 months. During this postoperative follow-up period, relatively high treatment success rates were achieved, ranging from 69.9 to 100%. In most studies, treatment success rates exceeded 80% (Table 1) [24,25].

Table 1: Results of perineal urethrostomy for urethral stricture