Reconstructive Urology

Reconstructive urology focuses on restoring the function and structure of the urinary tract and genital organs.

Common Reconstructive Urology Conditions

This subspecialty addresses various conditions resulting from congenital anomalies, trauma, cancer treatments, or other medical conditions.

Reconstructive urology procedures can dramatically improve a patient’s quality of life by alleviating discomfort, restoring normal urinary function, and addressing structural issues.

In Australia, reconstructive urologists are highly skilled in complex surgical techniques, including minimally invasive and robotic-assisted surgeries, which offer faster recovery times and improved outcomes for patients.

Below are several conditions commonly treated in reconstructive urology, their causes, symptoms, risk factors, and treatment options.

Urethral Stricture

Overview

A urethral stricture is a narrowing of the urethra, the tube through which urine exits the body. This can lead to difficulty urinating and a risk of infections. Strictures can vary in length and severity.

Causes

Urethral strictures may result from injury, infections (such as sexually transmitted infections), previous surgeries, or chronic inflammation.

Symptoms

Weak or slow urine stream
Painful urination
Difficulty starting urination
Frequent urinary tract infections (UTIs)
Dribbling after urination

Risk Factors

Previous urethral injury or surgery
Prostate surgery
Infections
Use of catheters

Treatment Options
Treatment depends on the severity of the stricture. Options include:

Urethral Dilation: A procedure to widen the urethra using special instruments.
Urethrotomy: A minimally invasive procedure using a small endoscope to cut through the stricture.
Urethroplasty: Surgical reconstruction of the urethra, often required for longer or more severe strictures. This approach has high success rates and may involve tissue grafts to rebuild the urethra.

In Australia, urethroplasty is a well-established procedure performed by reconstructive urologists, with good long-term outcomes for patients.

Bladder Exstrophy

Overview

Bladder exstrophy is a rare congenital condition where the bladder and part of the abdominal wall are not properly formed, leaving the bladder exposed on the outside of the body. This condition requires specialised, multidisciplinary care.

Causes

Bladder exstrophy occurs due to abnormal development of the bladder and surrounding structures during foetal growth. The exact cause is unknown, but it may be influenced by genetic and environmental factors.

Symptoms

Visible bladder outside the abdominal wall
Difficulty urinating
Urinary incontinence
Potential kidney issues over time

Risk Factors

Family history of bladder exstrophy
Maternal age and other prenatal factors

Treatment Options

Treatment usually involves staged reconstructive surgery to close the bladder, repair the abdominal wall, and establish normal urinary function. In Australia, these surgeries are typically performed in specialised paediatric centres with highly experienced multidisciplinary teams.

Pelvic Fracture Urethral Injury (PFUI)

Overview

Pelvic fracture urethral injury is a type of injury that can occur when the urethra is damaged due to a pelvic fracture, often resulting from accidents or trauma. This can lead to urinary difficulties and sometimes requires complex reconstructive procedures.

Causes

PFUI is generally caused by high-impact trauma, such as car accidents or falls from heights, leading to fractures in the pelvis that damage the urethra.

Symptoms

Inability to urinate
Pain in the pelvic area
Blood at the urethral opening
Swelling around the scrotum or perineum

Risk Factors

High-impact accidents
Sports injuries or falls

Treatment Options

Catheterisation: An initial catheter may be placed to drain the bladder and allow the urethra to heal.
Endoscopic Realignment: This minimally invasive approach may be attempted shortly after the injury.
Urethroplasty: For patients who develop a stricture following initial treatment, surgical repair may be required to reconstruct the urethra and restore normal urine flow.

Specialised reconstructive urologists in Australia offer these procedures, often involving robotic-assisted techniques for increased precision.

Urinary Incontinence After Prostate Surgery

Overview

Urinary incontinence following prostate surgery (often for prostate cancer treatment) is a common issue, particularly stress urinary incontinence. This condition can affect quality of life, but there are effective treatment options available.

Causes

Urinary incontinence after prostate surgery can occur due to weakening or damage to the urinary sphincter muscle during surgery, which affects the bladder’s ability to control urine flow.

Symptoms

Leakage of urine, especially during physical activities such as coughing, sneezing, or exercising
Urgency to urinate

Risk Factors

Prostate cancer surgery (radical prostatectomy)
Radiation therapy for prostate cancer
Previous bladder issues

Treatment Options
Treatment may include:

Pelvic Floor Physiotherapy: Specialised exercises to strengthen the pelvic floor muscles, which may reduce incontinence symptoms.
Urethral Bulking Agents: Injections that help to add volume around the urethra to reduce leakage.
Male Sling Procedure: A surgical option where a supportive sling is placed around the urethra to improve urinary control.
Artificial Urinary Sphincter: A more advanced surgical option that involves implanting a device to control urine flow. This is often reserved for more severe cases.

In Australia, these treatments are widely available, and urologists often work with physiotherapists to provide comprehensive care for incontinence following prostate surgery.

Peyronie’s Disease

Overview

Peyronie’s disease is a condition characterised by the development of scar tissue, or plaque, within the penis, leading to curvature that can cause pain and erectile dysfunction. While mild cases may not require treatment, more severe cases can affect sexual function.

Causes

The exact cause is not always known, but it may be related to injury or microtrauma to the penis. In some cases, it may be associated with genetic factors or autoimmune conditions.

Symptoms

Noticeable curvature of the penis
Pain during erections
Erectile dysfunction
Presence of lumps or hard areas under the skin

Risk Factors

Family history of Peyronie’s disease
Repeated trauma to the penis
Certain connective tissue disorders

Treatment Options

Medications: Injections, such as collagenase, can help break down plaque and reduce curvature.
Shockwave Therapy: This non-invasive option uses sound waves to break up plaque and may improve symptoms in some cases.
Surgery: For severe cases, surgical options include plaque removal or grafting to correct the curvature, or penile implants for men with erectile dysfunction.

In Australia, Peyronie’s disease treatment is available through specialised urology clinics offering advanced therapeutic options.

Ureteral Reconstruction

Overview

Ureteral reconstruction addresses blockages or strictures in the ureters (tubes that carry urine from the kidneys to the bladder), which can impede urine flow and lead to kidney damage if untreated.

Causes

Causes of ureteral stricture include previous surgeries, kidney stones, trauma, radiation therapy, or congenital anomalies.

Symptoms

Pain in the side or back (flank pain)
Reduced urine output
Recurring UTIs
Blood in urine

Risk Factors

Previous abdominal or pelvic surgeries
History of kidney stones
Trauma to the ureter area

Treatment Options

Endoscopic Procedures: Minimally invasive techniques like balloon dilation or stent placement may be used to open up the stricture.
Robotic-Assisted Surgery: Robotic techniques are often used for reconstructive surgery, allowing precise removal or bypass of the blocked section.
Tissue Grafts or Flaps: For complex strictures, tissue grafts may be used to reconstruct the ureter.

Australian reconstructive urologists employ cutting-edge robotic technology to ensure high success rates and faster recovery.