16544 Posterior Urethral Reconstruction

Overview

Posterior urethral reconstruction is an operation to repair a narrowed or damaged part of the posterior urethra. The urethra is the tube that carries urine from the bladder to the outside of the body. The posterior urethra is the section just below the bladder. When this section becomes narrowed or scarred, urine flow can be blocked or slowed. The surgery rebuilds that section to help urine pass more freely.

Posterior urethral narrowing that needs reconstruction is uncommon. It is a specialised procedure, so you may be referred to a centre with experience in this type of surgery.

It mostly affects men and boys, often after a pelvic injury or urethral injury. It can also happen after surgery, catheter use, infection, radiation, or a birth difference in the urinary system.

Symptoms

Common symptoms

• A weak urine stream
• Straining or pushing to pass urine
• Dribbling after urinating
• Feeling that the bladder is not fully empty
• Needing to urinate often or in a hurry
• Pain or burning when passing urine
• Repeated urine infections
• Blood in the urine
• Leakage of urine or trouble controlling urine

Symptoms in children

• A weak or spraying urine stream
• Wetting during the day or night after being dry
• Straining to pass urine
• Repeated urine infections
• Needing to urinate very often
• Poor feeding, poor growth, or feeling unwell if urine flow is badly blocked

Symptoms in older adults

• Suddenly not being able to pass urine
• Repeated urine infections
• New leakage or loss of bladder control
• Getting up often at night to urinate
• Confusion or tiredness during a urine infection
• Changes in kidney function found on blood tests

Causes

Main causes

• Pelvic injury or fracture that damages the posterior urethra
• Injury from a urinary catheter or an instrument passed into the urethra
• Surgery near the bladder, prostate, or urethra
• Infection or inflammation that causes scarring
• Radiation treatment in the pelvic area
• Birth differences or congenital narrowing of the urinary tract

Risk factors

• Pelvic trauma, especially a fracture
• Long-term or traumatic catheter use
• Previous urethral or prostate surgery
• History of urethral infection or inflammation
• Radiation to the pelvis
• Being male, and some congenital urinary conditions

When to see a doctor

See a doctor urgently if:

• You cannot pass urine or have severe lower belly pain.
• You have fever, chills, or feel very unwell with urinary symptoms.
• There is blood in your urine, or your catheter stops draining.

Book a routine appointment if:

• Your urine stream is weaker than usual.
• You strain, dribble, or still feel full after passing urine.
• You get repeated urine infections or need to urinate often.
• You have leakage or pain when passing urine.

Diagnosis

A doctor will ask about your symptoms, past injuries, surgeries, catheter use, and infections. They will examine you and may refer you to a urologist. A urologist is a doctor who specialises in urinary problems and male reproductive health.

Tests that may be done

• Urine test to look for infection or blood
• Ultrasound scan of the bladder and kidneys
• Uroflowmetry, a test that measures how fast you pass urine
• Urethrogram, an X-ray test that uses dye to show the urethra
• Cystoscopy, a test using a thin camera to look inside the urethra and bladder
• Blood tests to check kidney function

What to expect at your appointment

Most tests are quick and done as an outpatient. Some tests use a thin camera or dye and may feel uncomfortable, but your team will explain what will happen and help you prepare. Ask questions before you agree to any test.

Treatment

Treatment aims to restore urine flow and protect the bladder and kidneys. Your team will consider your age, general health, the cause, and how long the narrowed section is. Options range from monitoring and bladder drainage to surgery. Posterior urethral reconstruction is usually offered when other options do not work or are not suitable.

Self-care at home

• Drink enough fluids unless your team tells you to limit them.
• Avoid straining to pass urine; take your time and relax.
• Prevent constipation with fibre, fluids, and gentle activity.
• Keep your catheter and surrounding skin clean if you have one.
• Follow your team's instructions about activity, lifting, and follow-up.
• Do not stop or change prescribed medicines without asking your team.

Medical treatments

Your team may treat urine infections, pain, constipation, or bladder spasms with medicines they prescribe. They may also teach bladder training, catheter care, and ways to empty your bladder more fully. These treatments can ease symptoms, but they cannot remove scar tissue that is blocking urine. Surgery may be needed for that.

When is surgery considered?

Surgery is considered when narrowing causes repeated infections, kidney or bladder problems, inability to pass urine, or bothersome symptoms that do not improve with other care. The operation uses tissue to rebuild the narrowed section. Your surgeon will explain the risks, benefits, and what recovery involves.

Living with this condition

After reconstruction, you may have a catheter for a short time and need follow-up visits. Urine flow often improves, but healing takes time. Follow your team's plan for fluids, activity, and wound care. Tell them about fever, pain, leakage, or changes in urine.

Lifestyle tips

• Stay active gently; avoid heavy lifting until your team says it is safe.
• Avoid smoking, as it slows healing and raises infection risk.
• Keep a healthy weight and treat constipation early.
• Use good hygiene and follow catheter instructions carefully.
• Plan travel and work around follow-up appointments.

Diet and exercise

Eat a balanced diet with fibre to prevent constipation. Drink fluids regularly unless told otherwise. Gentle walking helps circulation and healing. Ask your team when you can return to sport, heavy work, or swimming.

Mental health and emotional wellbeing

Urinary problems can cause embarrassment, worry, low mood, or strain relationships and intimacy. These feelings are common. Talk to your team — they can help with practical advice and emotional support. If you feel in crisis or unsafe, contact your local emergency number or a crisis service right away.

Prevention

Not all cases can be prevented. You can lower risk by seeking care after pelvic injury, treating urinary infections promptly, using catheters only when needed and with good care, and following up after urethral surgery. Quitting smoking supports healing.

Vaccines

There is no vaccine for urethral narrowing. Keep up with routine vaccines your clinician recommends, especially before surgery.

Screening programmes

There is no routine screening test for posterior urethral narrowing. If you have had pelvic trauma, long-term catheters, or urethral surgery, tell your doctor about urinary symptoms early.

Complications

If left untreated

• Urinary retention, when you cannot pass urine
• Repeated urine infections
• Bladder stones or bladder damage
• Kidney damage
• Urine leakage or incontinence
• A fistula, an abnormal connection between the urethra and nearby tissue
• Sexual problems such as pain or changes in ejaculation

Long-term outlook

Many people have better urine flow after reconstruction, and most recover well with follow-up. Healing can take weeks to months. Some narrowing can come back and need more treatment, so keep your follow-up appointments. Your team can support you at every step.

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