How you urinate after a penectomy depends on whether the surgery was partial or total. In a partial penectomy, urine still exits through the remaining portion of the penis, and most people can urinate standing up. In a total penectomy, the urethra is rerouted to a new opening between the legs called a perineal urethrostomy, and urination is done sitting down.
Urination After a Partial Penectomy
A partial penectomy removes the end of the penis but leaves enough length to preserve the urinary opening. Because the urethra remains intact and exits at the tip of the remaining shaft, the basic mechanics of urination don’t change dramatically. Most people can still urinate while standing.
During surgery, the urethra is typically shaped in a way that prevents the stream from spraying or splitting. Surgeons open the end of the urethra slightly (a technique called spatulation) so urine flows in a more focused stream rather than splaying outward. The goal is a urinary stream you can aim and direct without significant mess. Some people find the shorter length makes aiming slightly less precise, and a few prefer to sit down for convenience, but standing urination remains an option for most.
Urination After a Total Penectomy
When the entire penis is removed, the urethra can no longer exit from its original location. Instead, it is rerouted to a surgically created opening called a perineal urethrostomy, positioned in the perineum, the area between the scrotum (or where it was) and the anus. The urethra is brought through this new site and stitched to the surrounding skin to form a stable, permanent opening.
Because this opening faces downward, urination is done while sitting on a toilet. The process itself is the same as before in one important sense: your bladder still contracts naturally, and urine flows out through the urethra under its own pressure. You don’t need any device or manual effort to empty your bladder. The main difference is positioning. Sitting allows gravity to direct the stream into the toilet. Many people who undergo this procedure report that once they adjust to the new routine, the act of urinating feels relatively normal, just from a different position.
The Catheter Period After Surgery
Regardless of which type of penectomy you have, you won’t be urinating on your own right away. A catheter is placed during surgery to drain urine while the surgical site heals. According to Cleveland Clinic, this catheter typically stays in place for up to two weeks. During this time, urine drains continuously into a collection bag, so there’s no need to actively urinate.
Once the catheter is removed, you’ll begin urinating through the new or modified opening. The first few times can feel unfamiliar, and some people experience mild stinging at the surgical site as it finishes healing. Your care team will typically confirm that you can empty your bladder adequately before you leave the hospital or at a follow-up visit.
Practical Adjustments for Daily Life
For people with a perineal urethrostomy, sitting to urinate is the biggest lifestyle change. Public restrooms designed for standing use become less practical, and many people shift to using a stall exclusively. At home, the adjustment is usually straightforward since the mechanics are identical to how many people already use a toilet.
One concern people have is whether sitting affects how completely the bladder empties. Research using real-time imaging has shown that body position does influence bladder mechanics. In upright postures, the pelvic floor muscles shift in a way that opens the angle between the bladder and urethra more fully, which can make emptying slightly more efficient. In practical terms, though, sitting on a toilet is an upright seated position, not lying down, and most people empty their bladders well in this posture. If you notice a weak stream or a feeling that your bladder isn’t emptying fully, that’s worth mentioning at a follow-up appointment, as it could signal narrowing at the new opening rather than a position issue.
Urethrostomy Maintenance
The perineal opening can sometimes narrow over time, a complication called stenosis. This happens because scar tissue forms as the body heals, and it can gradually reduce the size of the opening. Signs include a progressively weaker stream, straining to urinate, or frequent urinary infections. Minor narrowing can often be treated with a simple in-office procedure to widen the opening. Keeping the area clean and attending follow-up appointments helps catch this early.
What the Adjustment Feels Like
The physical act of urinating after a penectomy, once healed, is not painful or difficult for most people. The bigger adjustment tends to be psychological. Relearning a basic bodily function in a new way takes time, and it’s normal for the change to feel disorienting at first. People who’ve had a total penectomy sometimes describe a period of weeks to a few months before the new routine starts to feel automatic. For those with a partial penectomy, the adjustment is generally quicker since the overall process stays largely the same.