Reconstructive urology
This includes treatment for stricture urethra and pelvic fracture urethral injuries.
We offer reconstructive solutions for stricture urethra including single stage reconstruction, panurethral stricture repair and surgery for pelvic fracture urethral injuries.
We offer the procedures listed below.
- Retrograde urethrogram, Voiding cystourethrogram
- Urethral dilatation, Direct visual internal urethrotomy
- Dorsal onlay urethroplasty
- Ventral onlay urethroplasty
- Single stage urethroplasty for panurethral strictures
- Double face reconstruction
- Progressive perineal anastomotic urethroplasty
- Trans abdominal urethroplasty
- Perineal urethroplasty
Stricture urethra
- I have a poor urine flow. What is the cause ?
Poor urine flow can be due to obstruction to flow such as a stricture urethra (narrowing in the urine tube) or prostatic enlargement. Occasionally this can be due to weak bladder musculature.
- What is stricture urethra and what are the causes ?
Stricture urethra is a narrowing in the urine tube (urethra) and decreases the urine flow with increased frequency of urination (due to inadequate bladder emptying). Stricture urethra can occur due to lichen sclerosis (a skin disorder affecting the external genitalia), infection, trauma, instrumentation, radiation treatment for prostate cancer or as a result of poor catheterization technique.
- How do you diagnose stricture urethra ?
Diagnosis of stricture urethra is achieved by performing a retrograde urethrogram (X-ray taken after instilling a small amount of contrast in the urethra) and/or a voiding cystourethrogram (patient is made to pass urine after filling the bladder with contrast and an X-ray is taken). Another method is on visualization of the stricture on direct inspection with a telescope (cystoscopy).
- What is the treatment for stricture urethra ?
This depends on the cause, location, length of the stricture and the surrounding fibrosis.
The available options include –
- Dilatation or urethrotomy – this procedure aims to stabilize the urethral size by stretching the narrow portion or cutting into the narrow portion.
- Urethroplasty – this is a definitive procedure to augment the urethral lumen and is used in cases where the stricture recurs after dilatation or urethrotomy.
Various types of urethroplasty procedures are used to treat stricture urethra –
- Augmented anastomoses –
- Dorsal onlay
- Ventral onlay
- Dorsal inlay
- Ventral inlay
- Double face
- Flaps
- Substitution anastomoses –
- Pedicled preputial tube
- Anastomotic urethroplasty
- Non transecting anastomotic urethroplasty
- Augmented anastomotic urethroplasty
- Perineal urethroplasty
The exact nature of surgery needs to be discussed with our Urologist.
Pelvic Fracture Urethral Injury
- What is pelvic fracture urethral injury (PFUI) ?
10% of pelvic fracture cases are complicated by urethral (urine tube) injury. The commonest cause is road accidents. The patient is unable to pass urine or there is blood at the tip of the penis.
Acute management includes bypassing the urine with a tube inserted directly in the bladder (SPC) from the lower part of the abdomen.
- What evaluation is required for patients with PFUI ?
A thorough history, examination, erectile function status, retrograde urethrogram (X-ray taken after instilling a small amount of contrast in the urethra) and voiding cystourethrogram (patient is made to pass urine after filling the bladder with contrast and an X-ray is taken), penile doppler (to assess blood flow) is required.
- What is the definitive management for PFUI ?
A stepwise approach is utilized to treat PFUI. A perineal incision (cut between scrotum and anus) is utilized and the two ends of the urethra are identified, scar tissue excised and the two ends are joined together over a catheter tube.
Occasionally a combined abdominal and perineal incision is required.
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