The "7-flap" perineal urethrostomy

Objectives: Perineal urethrostomy is a well-accepted reconstructive option for complex anterior urethral stricture disease. We present a novel technique for the construction of a perineal urethrostomy that allows the surgeon greater control when managing all levels of anterior urethral stricture disease. Methods: A perineal urethrostomy is constructed by advancing a 7-shaped laterally based perineal skin flap to the amputated bulbar or membranous urethra. Results: Ten men between the ages of 48 and 79 underwent the 7-flap perineal urethrostomy for advanced urethral stricture disease; one had 7-flap revision of an existing perineal urethrostomy. Each patient was treated in an outpatient setting without perioperative complications. Nine of ten patients (90%) are voiding spontaneously without the need for urethrostomy revision or proximal urinary diversion. Conclusions: The 7-flap perineal urethrostomy is versatile, safe, and effective. It allows the surgeon maximal flexibility in the management of complex anterior urethral stricture disease.