Reconstructive Urology

This includes treatment for stricture urethra and pelvic fracture urethral injuries.

Information

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 strictured 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.

Prosthetics

What is the prevalence of Erectile Dysfunction (ED)?

Erectile dysfunction (ED) is the persistent inability to attain and maintain an erection for satisfactory intercourse. The overall prevalence of ED in Australia is 40%.

What are the causes for ED?

The cause is multifactorial – diabetes, atherosclerosis, raised cholesterol, smoking, excessive alcohol intake, obesity and advanced age.

What can I do to improve ED?

Lifestyle changes to improve diet, exercise, stop smoking, reducing alcohol intake and loss of weight is beneficial.

What are the treatment options?

Oral tablets, injectable agents and penile prosthesis are available for treatment.

What is a penile prosthesis?

Penile implant includes a pair of cylinders implanted in the penis, a pump placed inside the scrotum, and a reservoir of saline placed in the lower abdomen. Squeezing and releasing the pump moves fluid into the cylinders, creating an erection. Deflate the device by pressing the deflate button on the pump. The penis then returns to a soft, flaccid and natural-looking state.

What is the cause for male incontinence?

13% of Australian males suffer from incontinence and 30% are over the age of 70 years. The majority of cases result from an enlarged prostate gland or from surgery (prostatectomy) or radiation therapy for prostate cancer. Some cases may be due to an overactive bladder.

What is the incidence of post prostatectomy incontinence (PPI)?

Post prostatectomy incontinence (PPI) may range from mild to severe incontinence. Most resolve by one year after prostatectomy.

What treatment options are there for post prostatectomy incontinence?

The options include a male sling or an artificial urinary sphincter.

The male sling system is a reliable option for the treatment of male stress urinary incontinence (SUI). The implanted device works automatically, requiring no action on the patient’s part.