Reconstructive urology

Understanding the obstruction

Reconstruction may be considered for a ureteric stricture, narrowing at the kidney’s drainage junction, injury or a complication after earlier surgery. Imaging and sometimes endoscopic assessment help define the anatomy and tissue available for repair.

Kidney function, active infection and the need for temporary drainage are important parts of the assessment.

The repair is matched to the problem

• Pyeloplasty: reconstruction of a narrowed junction between the kidney pelvis and ureter.
• Ureteric reimplantation: reconnecting the ureter to the bladder, sometimes using bladder mobilisation or a flap.
• Graft reconstruction: selected repairs using tissue such as a buccal mucosal graft.
• Complex upper tract repair: selected procedures such as ureterocalicostomy when standard reconstruction is unsuitable.
• Transplant reconstruction: assessment of narrowing affecting a transplanted kidney’s drainage.

Planning with Dr. Sachin

The consultation considers the intended repair and alternatives, which may include endoscopic treatment, a stent, nephrostomy or another operation. A robotic approach can help with selected reconstructive work, but an open operation may be appropriate.

Bring all earlier operation notes, stent and nephrostomy details, urine culture results and the actual imaging. A history of several previous procedures is particularly relevant.

Healing and follow-up

Temporary stents, catheters or drains may protect the repair. Follow-up is needed to assess drainage and kidney function after removal. Possible problems include infection, urine leakage, recurrent narrowing and the need for another procedure.

• What is the cause and length of the narrowing?
• How much function does the affected kidney have?
• What alternative repairs may be required?
• When will any tubes be reviewed or removed?

Common questions