Reconstructive Urology
Repeated dilatation rarely cures a stricture. Definitive reconstruction usually does.
Understanding Reconstructive Urology
Reconstructive urology restores normal structure and function to the urinary tract after narrowing, injury, disease or previous surgery. The commonest indication is urethral stricture — scar tissue narrowing the urethra and obstructing urine flow.
Strictures are frequently managed elsewhere with repeated dilatation or internal incision. These procedures give short-term relief but carry high recurrence rates, and each repetition creates further scarring that makes definitive repair progressively more difficult.
Urethroplasty — open surgical reconstruction, often using a graft of buccal mucosa taken from inside the cheek — offers substantially better long-term outcomes for most strictures. It is technically demanding surgery, and results depend heavily on accurate preoperative assessment and surgical experience.
Symptoms
- Progressively weakening urinary stream
- Straining to urinate, or a spraying or split stream
- Prolonged voiding time and incomplete emptying
- Recurrent urinary tract infections
- Complete inability to pass urine
- Post-void dribbling
- Pain during urination
- Recurrent symptoms after previous dilatation or urethrotomy
If you recognise several of these, an assessment is worthwhile. Early evaluation usually means simpler treatment.
Causes & Risk Factors
Trauma
Pelvic fracture, straddle injury and direct perineal trauma are among the commonest causes of stricture in younger men.
Iatrogenic injury
Prolonged or traumatic catheterisation, previous endoscopic surgery and instrumentation — collectively the largest single group.
Infection and inflammation
Untreated urethritis, including sexually transmitted infection, causing inflammatory scarring.
Lichen sclerosus
A chronic inflammatory skin condition affecting the glans and urethra, producing progressive and often long-segment strictures.
Congenital abnormality
Hypospadias and other developmental conditions, including complications arising from childhood repair.
Radiation therapy
Pelvic radiotherapy causing fibrosis of the urethra or bladder neck.
Repeated dilatation
Paradoxically, repeated instrumentation itself creates additional scarring and worsens the underlying stricture over time.
Diagnosis at RAMS
We diagnose before we treat. Each step below is chosen for what it will actually change about your management.
Uroflowmetry
A characteristic flat, plateau-shaped flow curve strongly suggests stricture and provides an objective baseline.
Retrograde urethrogram and micturating cystourethrogram
Contrast imaging that defines stricture location, length and number — the essential information for planning reconstruction.
Urethroscopy
Direct visual inspection of the urethral lumen and assessment of tissue quality.
Ultrasound assessment
Evaluating post-void residual, bladder wall changes and upper tract effects.
Urine culture
Treating infection before any reconstructive surgery is undertaken.
Assessment of graft sites
Examination of the oral cavity where buccal mucosal graft is planned.
Treatment Options
Treatment is matched to the cause and to your circumstances. Every option, including doing nothing for now, is explained before you decide.
Optical internal urethrotomy
Endoscopic incision of the stricture. Reasonable for a first, short, single bulbar stricture, but recurrence is common and repeating it is generally not advisable.
Anastomotic urethroplasty
Excision of the diseased segment with direct reconnection of healthy urethra. It offers excellent long-term success for short strictures.
Substitution urethroplasty with buccal mucosal graft
Tissue taken from inside the cheek is used to widen the urethra. Buccal mucosa is well suited to a wet environment and gives durable results in longer strictures.
Staged reconstruction
For complex, long or previously failed strictures, reconstruction is performed in two planned stages.
Hypospadias and redo surgery
Correction of congenital abnormality and revision of previously unsuccessful repairs.
Bladder neck and posterior urethral reconstruction
Repair after pelvic fracture injury or following prostate surgery.
Clean intermittent self-catheterisation
A maintenance option for selected patients who are not candidates for definitive reconstruction.
Benefits of Treatment
- Durable resolution rather than repeated temporary procedures
- Restoration of a normal urinary stream
- Prevention of bladder and kidney damage from chronic obstruction
- Reduction in recurrent urinary infections
- Freedom from repeated dilatation and instrumentation
- Correction of failed surgery performed elsewhere
Why Choose RAMS
A dedicated men's health centre in Hanamkonda — built so that sensitive concerns meet genuine specialist expertise.
20+ Years of Experience
Two decades of andrology and urology practice, including complex and revision cases.
Fellowship-Trained Andrologist
Formal sub-specialty training in andrology and men's health — uncommon in the region.
Everything Under One Roof
Consultation, diagnostics, day-care procedures and surgery at a single address.
Modern Surgical Equipment
Dedicated theatre with an operating microscope, endoscopy and uroflowmetry.
Complete Confidentiality
Private consulting rooms and access-controlled records, always.
Open 24 Hours
Urological emergencies attended round the clock, all seven days.
Dr. Rammohan Thatipamula
MBBS, MS, MCh Urology · Fellowship in Andrology & Men's Health
With more than 20 years in clinical practice, Dr. Rammohan is among the few specialists in the Warangal region with formal fellowship training in andrology alongside an MCh in urology. That combination means male sexual health, fertility and urological surgery are handled by one specialist, rather than split across departments.
Reconstructive Urology FAQs
Why does my stricture keep coming back after dilatation?
Because dilatation stretches and tears scar tissue rather than removing it, and the tearing heals by forming more scar. Recurrence rates are high, and each repetition tends to make the stricture longer and denser.
Is urethroplasty a major operation?
It is a specialised operation requiring an inpatient stay and a catheter for two to three weeks afterwards, but long-term success rates are high — considerably better than repeated endoscopic treatment for most strictures.
Why take a graft from inside the cheek?
Buccal mucosa is naturally adapted to a moist environment, has an excellent blood supply, is easy to harvest and leaves no visible scar. The donor site heals within a few weeks.
Will I be able to eat normally after the graft?
There is soreness in the mouth for about a week, managed with soft foods and analgesia. Normal eating resumes shortly afterwards and speech is unaffected.
Can a stricture damage my kidneys?
Yes, if left untreated for a long period. Chronic obstruction raises bladder pressure, which is transmitted back to the kidneys and can eventually impair function. This is why persistent poor flow should be properly investigated.
Talk to a specialist about reconstructive urology
Consultations are private, unhurried and completely confidential. We are open 24 hours, all seven days, in Hanamkonda.
Hospital Street, Hanamkonda, Telangana 506001 · Open 24 hours, all days