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Reconstructive urology is an emerging sub-specialty that focuses on restoring normal urine flow in both the upper and the lower urinary tract. Conditions addressed by reconstructive urologists include ureteropelvic junction (UPJ) obstruction, ureteral stricture, neurogenic bladder, and urethral stricture disease. The primary focus of reconstructive urology is urethral reconstruction.
The urethra is the conduit through which urine is expelled from the bladder during micturition, or voiding. The urethra extends from the base of the bladder out the tip of the penis in a male and from the base of the bladder into the anterior vagina in a woman.
A urethral stricture is a scar occurring anywhere in the urethra, causing stenosis, or narrowing, of the urethral lumen. They are much more common in males than in females. Urethral strictures are caused by a variety of conditions including pelvic or perineal trauma, prior urologic procedures performed through the urethra, prostate cancer surgery, pelvic irradiation, sexually transmitted diseases, previous hypospadias repair, and lichen sclerosis (a poorly understood inflammatory condition affecting the genital skin and urethra). In many cases, however, there is not an identifiable cause for urethral stricture.
Reconstructive urology employs various techniques to restore normal urine flow from the bladder during micturition. In the past, many strictures were treated by endoscopic incision, a procedure performed through the urethra where the stricture is incised (cut) in attempt to open the urethra to allow normal urine outflow. Current data shows that endoscopic incision has a high failure rate, requiring further procedures and in many cases worsening the urethral stricture. Emerging data shows that urethroplasty, a surgical technique where the stricture is excised (removed) and the urethra is reconstructed, has excellent cure rates. Reconstructive urologists use various techniques including penile skin flaps and extra-genital skin grafts in urethroplasty.
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