{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,27]],"date-time":"2026-05-27T14:05:42Z","timestamp":1779890742606,"version":"3.53.1"},"reference-count":47,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2026,5,27]],"date-time":"2026-05-27T00:00:00Z","timestamp":1779840000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>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\u2014in patients with extensive, recurrent strictures or in those with comorbidities that preclude formal reconstruction\u2014or 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.<\/jats:p>","DOI":"10.3390\/jcm15114133","type":"journal-article","created":{"date-parts":[[2026,5,27]],"date-time":"2026-05-27T12:31:56Z","timestamp":1779885116000},"page":"4133","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Role of Perineal Urethrostomy in Reconstructive Urology"],"prefix":"10.3390","volume":"15","author":[{"given":"Laura","family":"Velarde Ramos","sequence":"first","affiliation":[{"name":"Department of Urology, Hospital del Trabajador, Ram\u00f3n Carnicer 185, Santiago 7501241, Chile"},{"name":"Department of Urology, Hospital F\u00e9lix Bulnes, Avenida Mapocho 7432, Santiago 9081273, Chile"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5718-6964","authenticated-orcid":false,"given":"Francisco","family":"Martins","sequence":"additional","affiliation":[{"name":"Department of Urology, University of Lisbon School of Medicine, 1649-035 Lisbon, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,27]]},"reference":[{"key":"ref_1","unstructured":"Lumen, N., Campos-Juanatey, F., Dimitropoulos, K., Greenwell, T., Martins, F.E., Osman, N.I., Riechardt, S., Waterloos, M., Summerton, D.J., and Serafetinidis, E. (2025). EAU Guidelines on Urethral Strictures. EAU Annual Congress Madrid 2025, EAU Guidelines Office. Available online: https:\/\/uroweb.org\/guidelines\/."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"4443","DOI":"10.1007\/s00345-021-03795-2","article-title":"Evaluation of the efficacy of perineal urethrostomy for patients with anterior urethral stricture: Insights from surgical and patient-reported outcomes","volume":"39","author":"Shinchi","year":"2021","journal-title":"World J. Urol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"6636","DOI":"10.62347\/ENFI4449","article-title":"Total penectomy and perineal urethrostomy configuration in locally advanced penile cancer: Oncological, surgical and functional outcomes","volume":"16","author":"Falcone","year":"2024","journal-title":"Am. J. Transl. Res."},{"key":"ref_4","first-page":"500.e9","article-title":"Outcomes of perineal urethrostomy for penile cancer: A 20-year international multicenter experience","volume":"39","author":"Chipollini","year":"2021","journal-title":"Urol. Oncol. Semin. Orig. Investig."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1016\/j.urology.2018.08.009","article-title":"Changing Trends in Reconstruction of Complex Anterior Urethral Strictures: From Skin Flap to Perineal Urethrostomy","volume":"122","author":"Fuchs","year":"2018","journal-title":"Urology"},{"key":"ref_6","first-page":"689","article-title":"Comparison of perineal urethrostomy versus augmentation urethroplasty in anterior urethral stricture disease","volume":"90","author":"Sharma","year":"2023","journal-title":"Urol. J."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"142","DOI":"10.4103\/UA.UA_111_20","article-title":"Perineal urethrostomy: A single-stage viable option for complex anterior urethral strictures","volume":"13","author":"Singhal","year":"2021","journal-title":"Urol. Ann."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"548","DOI":"10.1016\/j.juro.2009.04.012","article-title":"Clinical Outcome and Quality of Life Assessment in Patients Treated with Perineal Urethrostomy for Anterior Urethral Stricture Disease","volume":"182","author":"Barbagli","year":"2009","journal-title":"J. Urol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"738","DOI":"10.1097\/JU.0000000000004169","article-title":"Perineal Urethrostomy for Complex Urethral Strictures: Long-Term Patient-Reported Outcomes From a Reconstructive Referral Center and a Scoping Literature Review","volume":"212","author":"Klemm","year":"2024","journal-title":"J. Urol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"565","DOI":"10.1016\/j.urology.2004.04.035","article-title":"Heroic measures may not always be justified in extensive urethral stricture due to lichen sclerosus (balanitis xerotica obliterans)","volume":"64","author":"Peterson","year":"2004","journal-title":"Urology"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"945","DOI":"10.1016\/j.eururo.2008.07.046","article-title":"Lichen sclerosus of the male genitalia and urethra: Surgical options and results in a multicenter international experience with 215 patients","volume":"55","author":"Kulkarni","year":"2009","journal-title":"Eur. Urol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"215","DOI":"10.1016\/j.urology.2015.11.057","article-title":"Outcomes for Management of Lichen Sclerosus Urethral Strictures by 3 Different Techniques","volume":"91","author":"Patel","year":"2015","journal-title":"Urology"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"504","DOI":"10.1016\/j.jpurol.2011.02.008","article-title":"Functional, cosmetic and psychosexual results in adult men who underwent hypospadias correction in childhood","volume":"7","author":"Rynja","year":"2011","journal-title":"J. Pediatr. Urol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"209","DOI":"10.1016\/j.urology.2017.09.029","article-title":"Urethral Reconstruction in Aging Male Patients","volume":"113","author":"Viers","year":"2018","journal-title":"Urology"},{"key":"ref_15","first-page":"91\u201398; discussion 99-100","article-title":"Perineostomy: The last oportunity","volume":"41","author":"Carrillo","year":"2015","journal-title":"Int. Braz. J. Urol."},{"key":"ref_16","first-page":"7902","article-title":"\u20187-flap\u2019 perineal urethrostomy: An effective option for obese men with devastated urethras","volume":"22","author":"Starke","year":"2015","journal-title":"Can. J. Urol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"106358","DOI":"10.1016\/j.ijscr.2021.106358","article-title":"Traumatic penile partial amputation caused by rubber band a case report","volume":"86","author":"Liarto","year":"2021","journal-title":"Int. J. Surg. Case Rep."},{"key":"ref_18","unstructured":"EAU Guidelines (2024). Guidelines on Penile Cancer. Edn. EAU Annual Congress Paris, EAU. Available online: https:\/\/uroweb.org\/guidelines."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"424","DOI":"10.1016\/j.euo.2020.06.003","article-title":"European Association of Urology Guidelines on Primary Urethral Carcinoma\u20142020 Update","volume":"3","author":"Gakis","year":"2020","journal-title":"Eur. Urol. Oncol."},{"key":"ref_20","first-page":"72","article-title":"Perineal urethrostomy: Still Essential in the Armamentarium for Transurethral Surgery","volume":"19","author":"Papagiannopoulos","year":"2017","journal-title":"Rev. Urol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"5382","DOI":"10.1016\/j.radcr.2025.05.095","article-title":"Managing bladder tumor with long-segment anterior urethral stricture: Perineal urethrostomy as a critical surgical solution","volume":"20","author":"Ouskri","year":"2025","journal-title":"Radiol. Case Rep."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"375","DOI":"10.1002\/bjs.1800020706","article-title":"The treatment of urethral stricture by excision","volume":"2","author":"Russell","year":"1914","journal-title":"Br. J. Surg."},{"key":"ref_23","first-page":"3","article-title":"Reconstruction of the male urethra in strictures: Application of the buried intact epithelium technique","volume":"176","author":"Johanson","year":"1953","journal-title":"Acta Chir. Scand."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"416","DOI":"10.1016\/S0022-5347(17)65730-6","article-title":"A technique for posterior urethroplasty","volume":"83","year":"1960","journal-title":"J. Urol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1223","DOI":"10.1016\/j.urology.2010.10.041","article-title":"The outcomes of perineal urethrostomy with preservation of the dorsal urethral plate and urethral blood supply","volume":"77","author":"Myers","year":"2011","journal-title":"Urology"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1111\/j.1464-410X.1968.tb09886.x","article-title":"Urethroplasty by scrotal flap for long urethral strictures","volume":"40","author":"Blandy","year":"1968","journal-title":"Br. J. Urol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1487","DOI":"10.1016\/j.urology.2010.10.053","article-title":"The \u201c7-flap\u201d perineal urethrostomy","volume":"77","author":"French","year":"2011","journal-title":"Urology"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"134","DOI":"10.34239\/ajops.v1i1.17","article-title":"A novel application of the Lotus petal flap in high-risk perineal urethrostomy: Principles and outcomes","volume":"1","author":"Reilly","year":"2018","journal-title":"Australas. J. Plast. Surg."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1403","DOI":"10.1007\/s00345-018-2522-1","article-title":"Versatile algorithmic midline approach to perineal urethrostomy for complex urethral strictures","volume":"37","author":"McKibben","year":"2019","journal-title":"World J. Urol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1153","DOI":"10.1016\/j.urology.2008.06.072","article-title":"Perineal urethrostomy stenosis repair with buccal mucosa: Description of technique and report of four cases","volume":"72","author":"Kamat","year":"2008","journal-title":"Urology"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1285","DOI":"10.1007\/s00345-017-2002-z","article-title":"Augmented perineal urethrostomy using a dorsal buccal mucosal graft, bi-institutional study","volume":"35","author":"DeLong","year":"2017","journal-title":"World J. Urol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1159\/000358556","article-title":"Revision of perineal urethrostomy using a meshed split-thickness skin graft","volume":"4","author":"Lumen","year":"2014","journal-title":"Case Rep. Nephrol. Urol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"956","DOI":"10.1097\/JU.0000000000000027","article-title":"Urinary and Sexual Function after Perineal Urethrostomy for Urethral Stricture Disease: An Analysis from the TURNS","volume":"201","author":"Murphy","year":"2019","journal-title":"J. Urol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"158","DOI":"10.5152\/tud.2020.20322","article-title":"Permanent perineal urethrostomy for anterior urethral strictures: A critical appraisal of long-term outcomes and erectile function","volume":"47","author":"Yadav","year":"2021","journal-title":"Turk. J. Urol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1552","DOI":"10.1016\/j.juro.2018.01.074","article-title":"Effect of urethroplasty on anxiety and depression","volume":"199","author":"Schober","year":"2018","journal-title":"J. Urol."},{"key":"ref_36","first-page":"51","article-title":"7-flap perineal urethrostomy","volume":"4","author":"Parker","year":"2015","journal-title":"Transl. Androl. Urol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"52","DOI":"10.1111\/j.1464-410X.1971.tb04934.x","article-title":"The results and complications of scrotal-flap urethroplasty for stricture","volume":"43","author":"Blandy","year":"1971","journal-title":"Br. J. Urol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"87","DOI":"10.21886\/2308-6424-2022-10-2-87-98","article-title":"Treatment of patients with anterior urethral strictures: The role of perineal urethrostomy","volume":"10","author":"Glukhov","year":"2022","journal-title":"Urol. Her."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"365715","DOI":"10.1155\/2015\/365715","article-title":"Perineal urethrostomy: Surgical and functional evaluation of two techniques","volume":"2015","author":"Lumen","year":"2015","journal-title":"Biomed. Res. Int."},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"Yura, E., Hofer, M.D., Yao, H.H., Barbagli, G., and Chee, J. (2019). Perineal Urethrostomy: A Pearl in Failed Urethral Reconstruction. Textbook of Male Genitourethral Reconstruction, Springer.","DOI":"10.1007\/978-3-030-21447-0_31"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"160","DOI":"10.1016\/j.urology.2019.11.064","article-title":"Perineal Urethrostomy for Complicated Anterior Urethral Strictures: Indications and Patient\u2019s Choice. An Analysis at a Single Institution","volume":"138","author":"Verla","year":"2020","journal-title":"Urology"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"856","DOI":"10.1111\/j.1464-410X.2011.10139.x","article-title":"Perineal urethrostomy","volume":"107","author":"Myers","year":"2011","journal-title":"BJU Int."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"1109","DOI":"10.1007\/s00345-023-04343-w","article-title":"Analysis of prognostic factors of failure in perineal urethrostomy","volume":"41","author":"Salas","year":"2023","journal-title":"World J. Urol."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"1267","DOI":"10.1007\/s00345-018-2267-x","article-title":"Perineal midline vertical incision verses inverted U incision in the urethroplasty: Which is better?","volume":"36","author":"Lin","year":"2018","journal-title":"World J. Urol."},{"key":"ref_45","doi-asserted-by":"crossref","unstructured":"Peterson, A.C. (2013). Perineal Urethrostomy. Advanced Male Urethral and Genital Reconstructive Surgery; Current Clinical Urology, Humana Press.","DOI":"10.1007\/978-1-4614-7708-2_32"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"182","DOI":"10.1016\/j.juro.2016.07.087","article-title":"Male Urethral Stricture: American Urological Association Guideline","volume":"197","author":"Wessells","year":"2017","journal-title":"J. Urol."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"64","DOI":"10.1097\/JU.0000000000003482","article-title":"Urethral stricture disease guideline amendment","volume":"210","author":"Wessells","year":"2023","journal-title":"J. Urol."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/11\/4133\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,27]],"date-time":"2026-05-27T13:18:38Z","timestamp":1779887918000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/11\/4133"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,27]]},"references-count":47,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2026,6]]}},"alternative-id":["jcm15114133"],"URL":"https:\/\/doi.org\/10.3390\/jcm15114133","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,27]]}}}