Letter to the editor: Comparison of perineal urethrostomy versus augmentation urethroplasty in anterior urethral stricture disease

Dear Prof. Pier Francesco Bassi, We read with interest the recent article by Sharma et al. detailing the comparison in outcomes of perineal urethrostomy and augmentation urethroplasty in patients with strictures of the anterior urethra. ¹

A detailed analysis of 80 patients is presented with specific emphasis on urinary and sexual function outcomes using validated questionnaires. Although significant drops in mean IPSS score and improvements in mean IIEF 5 score were noted, the results were not statistically significant. Nonetheless, the mean improvement in quality of life was significant for both groups. ¹

They highlight the work by Barbagli et al. who reported a 78% satisfaction rate after perineal urethrostomy although the follow up period was much longer with a mean of 62 months compared to the current paper. ²

The authors acknowledge that the stricture aetiology was not detailed in this study which is a pertinent point. Additionally, the follow-up period is very short at only 7.2 months and this is a limitation of this study.

Barbagli et al. reported that hypospadiasis accounted for 4.6%, catheter related aetiology was 13.3% and 50% had an unknown aetiology. ²

Specific to perineal urethrostomy the authors should acknowledge the study by Murphy et al. which examined the outcomes of 39 patients with long anterior urethral strictures who underwent perineal urethrostomy. ³ A failure rate of 14.5% at 2 years was noted yet no deterioration in sexual function was noticed.

Pertaining to specific outcomes following perineal urethrostomy the authors omit to mention the work by Kumar et al. who examined the role of the urethral stricture patient reported outcome measure (USS-Prom) in the pre and post operative perineal urethrostomy patient. ⁴

In our tertiary referral reconstructive unit perineal urethrostomy is offered to patients with complex anterior urethral disease with comorbidities, adult hypospadiasis patient who are unfit for staged graft reconstruction and those with previous failed urethroplasty, as a definitive reconstructive option. In addition to baseline assessment with IPSS, IIEF 5 and quality of life questionnaires we also employ the Core lower tract symptom score routinely both pre and post operatively. ⁵ In select cases, we have performed augmented perineal urethrostomy with buccal graft to improve long term neomeatal patency.

The authors conclude by stating that perineal urethrostomy is an underutilised reconstructive operation and are to be commended for highlighting the role of this surgical option in the comorbid stricture patient.