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Introduction We report a novel perineal urethrostomy procedure for complete loss of anterior urethral tissue. Case presentation A 74‐year‐old man had complete necrosis of the corpus spongiosum and corpora cavernosa after repeated transurethral surgical procedures. He had been managed with a suprapubic cystostomy tube for 10 years. A perineal urethrostomy was performed, and a posterior wall with an inverted U‐shaped perineal skin flap and an anterior wall with a buccal mucosal graft were created. Five months later, an internal urethrotomy was required for mild anastomotic stenosis. Thereafter, an indwelling Foley catheter was used for urine drainage at night to prevent restenosis of the neourethra and avoid excessive nocturia due to low capacity of the long‐time disused bladder, and the patient became catheter‐free during the daytime. Conclusion The method presented here is a reasonable option for patients lacking whole anterior urethral tissue.