Reconstructive urology: Find specialists & information

Reconstructive urology on the ureters

The repair of ureteral damage refers to all reconstructive urology measures on the draining ureters. In most cases, men are affected by damage to the ureters.

The urine produced in the kidneys reaches the bladder via the ureters. Reconstructive urology is used to treat narrowing of the ureters.

Depending on the location and size of the narrowing, various treatment methods are possible.

Development and consequences of a ureteral stricture

A ureteral stricture is often congenital. Other causes of ureteral stricture are

• Inflammations,
• ureteral stones,
• ureteral spasms due to colic,
• tuberculosis,
• connective tissue thickening of the ureter(Ormond's disease),
• scarring after radiotherapy for the treatment of malignant tumors or intestinal diseases.
• intestinal diseases.

Furthermore, ureteral injuries also occur as a result of surgical procedures (urological, abdominal surgery and gynecological). Trauma rarely triggers a ureteral injury.

A ureteral stricture obstructs the flow of urine from the renal pelvis into the bladder. This causes urine to accumulate and increases the pressure in the kidney.

Initially, this increase in pressure is noticeable in the affected person as flank pain. If the ureteral stricture remains untreated, it can ultimately lead to irreversible kidney damage. Those affected then require permanent dialysis treatment. In individual cases, kidney transplantation is an option.

Surgical methods of reconstructive urology for ureteral stricture

A ureteral stricture can be treated with reconstructive urology. The surgical method chosen depends on the location and size of the narrowing in the ureters.

• In individual cases, the ureter can be dilated in the case of short constrictions. The reconstructive urologist enters the ureter with his instruments through the urethra. A skin incision is not necessary.
• The narrowing is treated as part of reconstructive urology with thin permanent catheters in the ureter (ureteral stents). The urine transport from the kidney into the bladder is ensured by the splints.
• The constriction is removed by reconstructive urology. The ureter is shortened by the length by which it runs under the bladder mucosa to the mouth of the bladder. The shortened ureter is then mobilized and "reimplanted" into the bladder.
• The narrowed section of the ureter is removed as part of reconstructive urology and replaced with natural or artificial tissue.

Reconstructive urology deals with the surgical treatment of diseases of the urinary tract © yodiyim | AdobeStock

Reconstructive urology on the urinary bladder

Urine collects in the urinary bladder until it is released to the outside via the urethra during urination. Reconstructive urology of the urinary bladder deals with all disorders in the area of the urinary bladder.

The bladder can be damaged due to

• a congenital malfunction,
• changes in pressure over a certain period of time or
• a tumor disease

damage. The pressure-damaged parts of the bladder must be surgically removed. The bladder can remain intact.

In most cases, it must be removed by means of bladder replacement surgery.

Bladder replacement surgery in reconstructive urology

Reconstructive urology uses the body's own intestinal segments for bladder replacement surgery. Depending on the constitution and age of the patient, the small intestine or the large intestine is used.

Reconstructive urology on the urethra

The urethra carries urine from the bladder to the outside. A narrowing of the urethra impedes the flow of urine and thus the complete emptying of the bladder.

This can result in urinary tract infections and, in the worst case, permanent kidney damage due to urine retention.

Reconstructive urology attempts to take suitable measures to correct narrowing of the urethra in order to prevent consequential damage.

Development and consequences of urethral stricture

The narrowing of the urethra can be congenital or caused by

• injuries,
• tumors,
• infections or
• surgery in the area of the urethra

be acquired.

Signs of damage to the urethra are

• A weakened urine stream,
• pain when urinating,
• increased occurrence of bladder infections and
• flank pain.

Surgical methods for urethral stricture

A narrowing of the urethra can be treated with various reconstructive urology procedures. The choice of method depends on the location and severity of the narrowing. Age and constitution also play an important role.

• Dilation is the simplest method to heal a narrowing of the urethra. However, it can only be used for less pronounced constrictions. In most cases, it only leads to a temporary alleviation of symptoms. These intervals can be extended by intermittent catheter insertions.
• A tubular lattice structure(stent) can be used to stretch the urethra and keep it permeable. Even with this method of reconstructive urology, success is only temporary. The foreign body in the urethra can easily cause germs to colonize, which can lead to unwanted urinary tract infections.
• During slitting, the urethra is slit open under endoscopic vision and then splinted with a bladder catheter .
• In the case of short-segment constrictions, it is advisable to remove part of the urethra in the area of the penile shaft. For longer constrictions, reconstructive urology involves the use of a urethroplasty .

Reconstructive urology on the penis

Reconstructive urology also deals with congenital or acquired damage to the penis that impairs its function and causes suffering for the patient.

Surgical methods of reconstructive urology for penile curvature

Peyronie's disease is an acquired curvature of the penis. It can cause severe pain during erections and/or sexual intercourse for those affected or their partners. The causes of this clinical picture have not yet been sufficiently clarified.

In addition to the medical history and clinical examination, sonography (ultrasound) is also used to diagnose the condition. This can provide important information for surgical planning about

• the extent
• the localization,
• the degree of kinking and
• existing constrictions

and existing constrictions.

Reconstructive urology distinguishes between two surgical options for penile curvature: The healthy side of the penis is surgically shortened or the diseased side is stretched.

Both methods have their advantages and disadvantages and depend mainly on the degree of penile curvature.

If erectile dysfunction is present in addition to penile curvature, implantation of a penile prosthesis should be considered.

Surgical methods of reconstructive urology for erectile dysfunction

Reconstructive urology can be used if drug therapy or a vacuum pump does not help with erectile dysfunction.

The use of a penile prosthesis is then the only remaining option to (successfully) treat erectile dysfunction.

The penile prosthesis consists of three components:

• Two cylindrical implants are inserted into the erectile tissue.
• The pump fills and empties the cylinders and is surgically inserted into the scrotum.
• The fluid reservoir with which the cylinders are filled is located invisibly in the abdominal cavity.

It is advisable to clarify in advance whether the costs will be covered by health insurance.