Reconstructive Urology

Reconstructive urology is that branch of urology dealing with repair of damaged portions of the urinary tract.

The conditions treated include stricture urethra, urinary incontinence, bladder repair, correction of narrowing of the ureter or pelvis of the kidney (PUJ obstruction).

Stricture in the urethra is a narrowing of the urethral passage. This occurs most often after an infection, prolonged use of a urinary catheter or after trauma to the penis or the pelvis.

The urinary stream gets affected and may totally stop , needing diversion of the urinary passage by a Suprapubic Catheter

An initial assessment of the degree of narrowing is made by a dye test called Retrograde Urethrogram and Micturating Cystogram.

Thereafter the degree of tightness and the length of the urethra involved is assessed by a Urethroscopy and Cystoscopy

a. Optical Internal Urethrotomy (OIU)

Short segments of narrowing of the urethra can easily be managed by OIU operation . Here the narrowed portion is cut by inserting an instrument into the urethra and cutting through the narrow part till it is fully opened out.

b. Buccal Mucosa Urethroplasty (BMG – Urethroplasty) 

For longer segments of narrowing of the urethra , an open operation is needed. In this operation the urethra is opened from the perineum. The narrow part of the urethra is cut open .That segement of the urethra which is narrowed is patched with a graft of skin taken from the inner lining of the mouth – the buccal mucosa. This operation needs about 14-18 days to recover but gives durable long term results.

c. End- End Urethroplasty

When there Is a complete obliteration of the urethra from injury then the area of the block is fully cut out and the ends joined together by an open operation

Prostatectomy is an increasingly common surgery performed for treatment of Prostate Cancer

After this operation some patients suffer from the side effects of urinary incontinence or Erectile Dysfunction. In most cases these resolve with medication and physiotherapy.

Artificial Urinary Sphincter (AUS) 

If after 1 year there is still persistence of incontinence, then surgical correction is need. The most successful operation is insertion of Artificial Urinary Sphincter (AUS). This is a hydraullically operated device surgically inserted to wrap around the urethra and controlled by a subcutaneous implanted button 

In some patients there is a narrowing in the ureter at the point where it joins the kidney.