Urination does not require a penis. The urethra, the tube that carries urine from the bladder to the outside, runs through the pelvis well behind and beneath the penis itself. When the penis is partially or fully removed, whether from cancer surgery, traumatic injury, or gender-affirming procedures, surgeons reroute or preserve what remains of the urethra so that urine can still exit the body under the bladder’s own power. The specifics depend on how much tissue is removed and why, but the short version is that you keep peeing, just through a different opening.
Why Urination Still Works Without a Penis
The penis is essentially the last few inches of a much longer plumbing system. The bladder sits deep in the pelvis, and the urethra passes through the prostate gland and the pelvic floor muscles before entering the penile shaft. Those deeper segments, collectively called the posterior urethra, do the heavy lifting when it comes to controlling the flow of urine. The sphincter muscles that let you hold urine and release it on command sit at the bladder neck and around the prostate area, far from the tip of the penis. Removing part or all of the penile shaft does not touch those muscles. As long as the bladder and sphincters are intact, continence and voluntary urination remain possible.
Partial Penectomy and the Shortened Stream
When cancer is confined to the tip or the front portion of the penis, surgeons often perform a partial penectomy, removing just enough tissue to achieve clear margins while preserving as much length as possible. In these cases, the urethra is trimmed to match the new end of the remaining stump and stitched open so urine exits from the shortened penis. Most men who undergo this procedure can still urinate from a standing position, though spraying of the stream is the most commonly reported issue afterward.
The practical challenge is less about function and more about aim. A shorter penile remnant can make it difficult to direct the stream over the scrotum and into a toilet bowl. One published solution involves adapting a simple syringe barrel as a funnel to contain and aim the stream, which sounds crude but solves the problem effectively for daily life.1PubMed Central. Simple aid for upright voiding after partial penectomy Spraying tends to be the biggest ongoing nuisance rather than any loss of control over when and whether you can go.2Oxford Academic (Sexual Medicine Reviews). Functional outcomes and health-related quality of life following penile cancer surgery: a comprehensive review
Total Penectomy and the Perineal Urethrostomy
When cancer has invaded deeply enough that the entire penis must be removed, surgeons perform a total penectomy. In this situation, there is no penile stump left to urinate through. Instead, the standard approach is to create what is called a perineal urethrostomy: the remaining urethra is brought to the surface of the skin in the perineum, the area between the scrotum (or where the scrotum was) and the anus. This new opening, called a stoma, becomes the permanent exit point for urine.
From a functional standpoint, the procedure works. A study reporting outcomes for 15 patients with locally advanced penile cancer who underwent total penectomy with perineal urethrostomy found the procedure to be safe with acceptable complications and favorable functional results.3PubMed Central. Total penectomy and perineal urethrostomy configuration in locally advanced penile cancer: oncological, surgical and functional outcomes A larger international study spanning 20 years confirmed that perineal urethrostomy is the definitive form of urinary diversion for patients needing total penectomy for penile cancer.4Urologic Oncology: Seminars and Original Investigations. Outcomes of perineal urethrostomy for penile cancer: A 20-year international multicenter experience
The most significant lifestyle change is that you sit down to urinate. The stoma is located underneath the body, so standing at a urinal is no longer an option. Many men adapt to this without much difficulty, though the psychological adjustment can be harder than the physical one.
Complications of the Perineal Stoma
The new urinary opening is not immune to problems. The most common complication is stenosis, a narrowing of the stoma that restricts urine flow. In a study of nearly 300 patients with perineal urethrostomies, stenosis occurred in about 12% of cases. Among those who developed it, roughly three-quarters needed a surgical revision, typically around six months after the original procedure.5Clinical and Translational Radiation Oncology. Impact of radiation therapy on perineal urethrostomy for penile cancer Radiation therapy to the area, sometimes given alongside surgery for more aggressive cancers, can increase the risk of stenosis.
When stenosis develops, it typically announces itself with a weaker stream, difficulty starting urination, or a feeling of incomplete emptying. The fix usually involves surgically widening the stoma opening. In some cases, a simple dilation procedure in a clinic is enough; more significant narrowing requires a revision surgery under anesthesia. Once corrected, most patients go back to urinating without issues.
A separate evaluation of perineal urethrostomy techniques found significant improvement in peak urinary flow rates after surgery, though about one in five patients across two surgical approaches eventually experienced some degree of failure requiring further treatment.6PubMed Central. Perineal urethrostomy: surgical and functional evaluation of two techniques
What Happens Right After a Traumatic Amputation
Accidental or violent penile amputation is rare but does happen, and the immediate concern in the emergency room is stabilizing the patient and establishing a way for urine to drain. In the acute setting, surgeons typically place a suprapubic catheter, a tube inserted through the lower abdominal wall directly into the bladder, to bypass the damaged urethra entirely while they assess what can be saved. One published case report described placing this catheter under direct visualization after filling the bladder with sterile water, then turning attention to the possibility of reattachment.7PubMed Central. Surgical Management of Traumatic Penile Amputation: A Case Report and Review of the World Literature
If the amputated penis is recovered and the patient reaches a surgical team quickly enough, microsurgical replantation is sometimes possible. This involves reconnecting the blood vessels, nerves, and urethra under a microscope. The results, when it works, can be remarkably good. A report on two successful replantations, both performed after more than 10 hours of ischemia time (meaning the severed tissue had been without blood flow for that long), showed both patients recovered normal urination, erectile function, and sensation.8PubMed Central. Two cases of successful microsurgical penile replantation with ischemia time exceeding 10 hours and literature review In another case of complete amputation, the replanted penis recovered well enough that the patient could urinate standing up with a peak flow rate of 20 milliliters per second, which is within the normal range.9PubMed. Microscopic replantation of completely amputated penis and testes: a case report and literature review
Replantation is not always feasible. The amputated tissue may be too damaged, too much time may have passed, or the patient may not be stable enough for a prolonged microsurgery. When reattachment is not an option, the treatment path converges with the cancer surgery approach: the remaining urethra is brought to a new skin surface, usually as a perineal urethrostomy.
Reconstruction and Phalloplasty
For patients who want to restore the ability to urinate through a reconstructed penis, phalloplasty is an option. This surgery builds a new phallus using tissue from elsewhere on the body, typically the forearm or thigh. A tube of tissue is fashioned into a neo-urethra that connects the native urethra to the tip of the new phallus, rerouting the urinary stream forward and potentially allowing standing urination again.
The technical challenge of creating a neo-urethra is substantial, and urinary complications are the most common issue after phalloplasty. Fistulas (abnormal openings where urine leaks through the skin) and strictures (narrowing of the new urethra) account for the majority of problems.10PubMed Central. Urethral stricture after phalloplasty One study found that total urethral complication rates, combining fistulas and strictures, ran above 70% regardless of whether the urethra was built from a free flap or a skin graft.11PubMed. Determining the outcomes of urethral construction in phalloplasty That number sounds alarming, but it includes complications that were managed successfully with additional procedures. After corrective surgeries, most patients end up with a working urinary channel.
Among patients undergoing reconstruction for strictures and fistulas following phalloplasty, a one-stage repair approach showed that about 15% developed recurrent strictures postoperatively, a meaningful improvement over the initial complication rates.12PubMed Central. Patient-reported outcomes after one-stage neourethral reconstruction in transmen with phalloplasty-associated strictures and fistulas The urinary complication rates following phalloplasty are similar whether the surgery is performed for a cisgender man after penile loss or for a transgender man as part of gender-affirming care, which suggests the difficulty is inherent to the engineering of the neo-urethra rather than the patient population.11PubMed. Determining the outcomes of urethral construction in phalloplasty
Not every patient who pursues reconstruction prioritizes standing urination. When surveyed, phalloplasty patients ranked having a normal-appearing phallus and minimizing complications as more important goals than the ability to urinate while standing.13PubMed Central. ‘Modified Phallourethroplasty’ as a Surgical Alternative to Phalloplasty With Urethral Lengthening: Technique, How We Present This Option to Patients, and Clinical Outcomes This has led some surgical teams to offer a “modified phallourethroplasty” that extends the urethra partway into the new phallus rather than all the way to the tip, reducing complication risk while still improving the cosmetic result. All patients in one series of this modified procedure reported satisfaction with both body image and urinary function.
Urinary Changes After Penile Inversion Vaginoplasty
Gender-affirming vaginoplasty for transgender women reshapes the existing anatomy rather than removing it entirely, but the urinary tract still undergoes meaningful changes. The urethra is shortened and repositioned to sit in a more anatomically female location. This rerouting brings its own set of urinary complications.
A systematic review and meta-analysis of urinary complications after penile inversion vaginoplasty found that a poor or splayed stream affected roughly 12% of patients. Meatal stenosis occurred in about 7%, and irritative symptoms like urgency, frequency, and nighttime urination affected a similar proportion. Incontinence was reported in about 9% of cases, urinary retention requiring catheterization in about 5%, and urethral stricture in about 5%.14PubMed Central. Urinary complications after penile inversion vaginoplasty in transgender women Systematic review and meta-analysis These complication rates are lower than those seen after phalloplasty, likely because the urethral shortening in vaginoplasty is a simpler anatomical rearrangement than building an entirely new urethral tube from scratch.
The key difference for daily life is that vaginoplasty patients urinate sitting down through a shorter urethra, which most find unremarkable since it mirrors how most women urinate. The complications that do arise, particularly stream spraying and meatal stenosis, are treatable, and the overall satisfaction rates with urinary function after vaginoplasty tend to be high.
Phantom Sensations and the Feeling of a Missing Organ
Just as people who lose a limb sometimes feel a phantom hand or foot, patients who have had a penectomy can experience phantom penile sensations. These can include a feeling that the penis is still present, phantom pain, and even a sensation of phantom erection or urination, despite the organ being gone.15PubMed Central. Psychiatric Approach in Phantom Erection Postpenectomy Patient These sensations do not interfere with actual urination through the stoma, but they can be disorienting, especially early on. The brain’s map of the body takes time to update, and in some cases, the phantom sensations persist for months or years. Treatment typically involves a combination of pain management and psychological support.
How Veterinary Surgery Mirrors the Human Approach
The same surgical principle used in humans, amputating obstructed anatomy and creating a new urethral opening, is one of the most commonly performed urological surgeries in cats. Male cats are prone to urinary blockages because their urethral anatomy includes a very narrow segment at the tip of the penis. When blockages recur, veterinarians perform a perineal urethrostomy: they remove the narrow penile urethra and create a wider stoma from the pelvic urethra, eliminating the bottleneck.16PubMed Central. Cystoscopy-assisted urolith retrieval via a perineal urethrostomy stoma in male cats
Long-term quality of life studies in cats confirm the approach works well. One study of 74 cats who underwent perineal urethrostomy found that quality-of-life outcomes five to 29 months later were reported as very good, leading the authors to recommend the procedure as a standard tool for managing recurrent urinary obstructions.17PubMed Central. Welfare of cats 5-29 months after perineal urethrostomy: 74 cases (2015-2017) Another study comparing two stoma locations in cats found that perineal placement had much better outcomes than a higher abdominal placement, with lower rates of urinary tract infections and skin irritation and far higher owner satisfaction.18PubMed Central. Clinical outcomes of 28 cats 12–24 months after urethrostomy
The feline experience is actually a useful reference point for understanding the human procedure. In both species, the surgery does not impair the bladder’s ability to store and release urine on its own terms. The only thing that changes is where the stream exits the body. Cats, of course, have no opinions about sitting versus standing, which eliminates what turns out to be the most psychologically loaded aspect of the procedure for human patients.