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Had Operation To Repair Hypospadias And Urethroplasty With Complex Urethral Reconstruction. Difficulty In Passing Urine With Weak Stream

Posted on Mon, 23 Sep 2013

Question: I have history of urological difficulties. I had several operation to repair hypospadias as a child. As a teenager (72 -75) I had urethroplasty. I had a revision in 2003 - 2006. It was a complex urethral reconstruction with numerous urethroplasties (with harvesting skin from mouth, ears, penis and upper arm) due to 2 episodes of MRSA. I am on prophylaxis.
I have difficulty in passing water. My stream is weak. My surgeon has suggested perineal urethrostomy.

Can I have another complete revision instead.

Answered by Dr. Dr. P. T. Patil (46 minutes later)

Brief Answer:
It is unlkely to be successful.

Detailed Answer:

Hello
Thanks for your query.

Based on the facts that you have posted it appears that you had Hypospadias and had undergone multiple surgeries in childhood to create a normal urinary passage to enable free passage of urine. However all the attempts have failed. This is called as Hypospadias Cripple.

This is due to avascular necrosis resulting from multiple surgeries. Now any more attempt to repair the urinary passage will be futile exercise.

Since you have developed stricture of the entire urethra and keeping your age in mind it will be better if you go for perineal Urethrostomy so that you can pass urine through the new opening freely without any difficulty. This will prevent further complications due to obstruction to urine flow.

Hope I have answered your query. If you have any more questions please feel free to ask me I shall be happy to help you
Dr.Patil.

Above answer was peer-reviewed by : Dr. Vaishalee Punj

Follow up: Dr. Dr. P. T. Patil (28 minutes later)

I am under care and supervision of Prof XXXXXXX UCL, London. Can you tell me what perineal urethrostomy entails? Where exactly is the opening? Is it close to rectum. What are the possible implications erectile functions? I have poor to middling erections now.
Would I have a stream after the operation? I will be concerned about sprays. What about quality of my unnation afterwards? Would I have great control over starting and stopping? Are there any hygiene issues? What about chances of infections?
What is the recovery period? Would I have catherisation after operation and for how long? What is the recovery period?
Many thanks

Answered by Dr. Dr. P. T. Patil (7 hours later)

Brief Answer:
You will have normal urine flow.

Detailed Answer:
Hello,

Thanks for follow up and glad to hear that you are under care of Prof XXXXXXX XXXXXXX one of the renowned re- constructive Urologist in the world.I happened to be his student in 1992 at UCL London..

I will try to answer your queries point to point.
1) Perineal urothrostomy is permanent opening created in proximal urethra at the level of perineum so that one passes out urine through this opening ( Urinary Diversion). It is placed just proximal to Scrotum away from rectum.The surgery is very simple .You will be catheterized for 5 days and would take one week for complete recovery.
2)There are no erectile problems due to Urothrostomy per Se .Your present problem of erection could be due to anxiety and needs to be evaluated .
3) You will have moderate stream without spraying after this surgery however you will need to pass urine only in sitting position to avoid soiling of cloths
4) There are no chances of infection however you will need to observe proper personal hygiene to keep the perineum clean every time after you pass urine .

Thanks and Regards.

Dr.Patil.

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Above answer was peer-reviewed by : Dr. Raju A.T