Reconstructive Urology

What reconstructive urology deals with

Urethral stricture

Scarring of the tube that carries urine out of the bladder, which narrows the channel and weakens the stream. Causes include injury, infection, previous instrumentation and catheters, and in many cases no cause is ever identified.

Ureteric narrowing

Scarring of the tube between kidney and bladder, often following stone treatment, previous surgery or radiotherapy. Left alone it can quietly damage the kidney behind it.

Blockage where the kidney meets the ureter

A narrowing at the outlet of the kidney, sometimes present from birth and sometimes caused by a crossing blood vessel. It causes the kidney to swell and can present with pain after drinking large volumes.

Injury to the urinary tract

Damage from pelvic fractures, road accidents or injury sustained during other abdominal and pelvic operations.

Abnormal connections

A fistula is an unwanted channel between the urinary tract and another structure, most often following surgery, obstructed labour or radiotherapy. It causes continuous leakage and needs surgical closure.

Symptoms that point to a narrowing

• A stream that has become slow, thin, sprayed or forked
• Straining to pass urine, and taking noticeably longer than you used to
• A sense that the bladder never empties completely
• Repeated urinary infections
• Pain in the flank, particularly after drinking a lot of fluid
• Continuous leakage that is not related to coughing or urgency

How it is assessed

The stream is measured objectively with a flow test, and an ultrasound shows how much urine remains in the bladder afterwards.

For the urethra, a contrast X-ray maps exactly where the narrowing sits and how long it is, and a telescopic look confirms it. Length and location are what decide the operation. For the upper tract, a CT scan and a kidney function scan show the anatomy and, importantly, how much working kidney is left behind the blockage, since that determines whether repair is worthwhile.

Repair approaches

Telescopic incision or dilatation

Short, thin strictures can be cut or stretched from inside. It is quick and involves no external cut, but the scar has a real tendency to reform, so it is best thought of as a limited solution rather than a permanent one.

Open reconstruction of the urethra

The scarred segment is either removed and the healthy ends joined, or the channel is widened using a graft of tissue taken from the inside of the cheek. This is the durable repair for longer strictures and is a considered operation rather than a quick fix.

Repair of the kidney outlet

The narrowed segment at the top of the ureter is removed and the ureter reconnected to the kidney with a wide, well drained join, relieving the pressure on the kidney.

Ureteric reconstruction

Depending on where the damage sits, the ureter is reimplanted into the bladder, the bladder is mobilised upwards to meet it, or a segment is replaced. The aim is a tension free, well vascularised repair that stays open.

Staged repair

Where scarring is extensive or tissue quality is poor, repair is deliberately done in two stages several months apart. It takes longer, and it produces a better final result than forcing a single operation.

Recovery

A catheter stays in place after most reconstructive procedures to keep the repair dry and protected while it heals. How long depends on the operation, and it is generally counted in weeks rather than days.

An X-ray is usually taken before the catheter is removed to confirm the repair has sealed. Follow up afterwards includes flow tests, because the point is not only that the repair healed but that the stream stayed good over time.