If the penis is removed or lost, you can still urinate. The penis is the outer exit point for the urethra, but the urethra itself is a longer tube that runs from the bladder through the pelvic floor. Surgeons reroute the remaining urethra to a new opening in the skin, typically between the scrotum (or where it was) and the anus. From that point on, urine leaves the body through this new opening, and most people sit down to use the toilet.
What Happens Immediately After Injury or Surgery
When the penis is lost suddenly through trauma, doctors focus first on draining the bladder safely while the area heals. A catheter is placed either through the remaining urethra or, if that’s not possible, directly through the lower abdominal wall into the bladder. This abdominal tube, called a suprapubic catheter, stays in place for weeks or sometimes months, giving damaged tissue time to heal before a permanent solution is created. If the urethra was cut or crushed during the injury, repair surgery typically happens three to six months later, once swelling has fully resolved.
In a planned removal (such as for penile cancer), the surgeon reroutes the urethra during the same operation, so there’s no gap where you can’t urinate on your own.
How the Permanent Reroute Works
The standard procedure is called a perineal urethrostomy. The surgeon makes an incision in the perineum, the patch of skin between the genitals and the anus, then opens the buried section of the urethra and stitches it to the surrounding skin. This creates a permanent, stable opening where urine exits the body. A catheter is placed through the new opening for a short time after surgery to keep everything draining while the stitches heal.
The result is a small opening that sits further back and lower than where the penis was. Because of its position, urinating while standing is impractical for most people. About a quarter of men who’ve had this surgery report needing to sit down to urinate, and in practice, sitting is the most common approach. Some people use a handheld funnel-style device to direct the stream if they prefer to stand at a urinal, but sitting is simpler and reduces mess.
How Reliable the New Opening Is
Perineal urethrostomy is a well-established surgery, but the new opening can narrow over time, a complication called stenosis. Studies put the rate of narrowing at roughly 5 to 22 percent of cases, with a large review finding an overall rate of about 12 percent. Most narrowing shows up within the first year. When it happens, it usually requires a minor corrective procedure to reopen the passage. The median time to that correction is about six months after the original surgery.
Leakage and spraying are more common complaints. In one study of men treated for penile cancer, 83 percent of those who had a partial or total removal reported some leakage during urination, compared to 43 percent in a group that had less extensive surgery. The most frequent causes were a spraying urine stream (35 percent of cases) and a shortened urethral opening (another 35 percent). These issues are manageable but often require adjustments in positioning, wiping habits, or clothing choices.
Reconstruction and Standing Urination
For people who want to restore the ability to urinate from the tip of a reconstructed penis, surgeons can build a new urethra as part of a phalloplasty. This involves extending the urinary channel through tissue grafted from the forearm or thigh. When it works, it allows standing urination through a more typical position.
The trade-off is a high complication rate. In a study of 136 patients, those who had urethral lengthening experienced fistulas (abnormal leaks through the new channel) 43 percent of the time and strictures (scar tissue narrowing) 60 percent of the time. Eighty-one percent needed at least one additional surgery, and 70 percent specifically needed reoperation for urinary complications. By comparison, patients who skipped the urethral extension and kept a perineal opening needed reoperation only 9 percent of the time.
Among those who did go through with urethral lengthening, 75 percent were eventually able to urinate while standing. The remaining 25 percent ended up converting back to a permanent perineal opening after complications proved too difficult to resolve. All of these outcomes typically unfold over multiple surgeries spanning a year or more.
Daily Life and Practical Adjustments
The biggest day-to-day change is sitting to urinate. For many people this is a minor adjustment, no different from what roughly half the population already does. Public restrooms with stalls work fine, though urinals become impractical without a standing device.
Hygiene takes a bit more attention. The perineal area is warmer and more enclosed than the tip of a penis, so keeping the opening and surrounding skin clean and dry matters more. Gentle washing during showers and patting dry after urination help prevent skin irritation. Some people find that wearing breathable cotton underwear and changing it more frequently reduces discomfort.
Bladder function itself is unaffected by the loss of the penis. The bladder still fills and empties normally, the urge to urinate feels the same, and the muscles that control the flow remain intact. What changes is the exit point and the mechanics of aiming, not the underlying plumbing.