Urethral strictures are relatively common in men. The most common cause is idiopathic in developed countries and trauma in developing countries. Iatrogenic injuries, such as insertion of indwelling urinary catheter or by instrumentation during trans-urethral surgery, account for almost 50 percent of all cases. Other causes of urethral strictures include pelvic fracture, STDs, hypospadias, lichen sclerosus as well as radiation therapy.
Ureteropelvic junction (UPJ) obstruction is a condition where there is blockage where the renal pelvis joins the ureter. The UPJ obstruction is both congenital and acquired. The reported incidence of UPJ obstruction is 1 in 500 live births screened by routine antenatal ultrasound and it is the most common anatomical cause of antenatal hydronephrosis. Boys are affected with UPJ obstruction more commonly than are girls. The reported rate of bilateral involvement is approximately 10 percent. Acquired causes for UPJ obstruction include ureteric stricture from instrumentation, urothelial carcinoma as well as infection such as Tuberculosis.
Removal of the bladder (cystectomy) necessitates reconstruction of the lower urinary tract. Bladder cancer is the most common reason for cystectomy. After cystectomy, in highly selected patient, one can consider the formation of a non-contractile new bladder using a segment of small bowel. The neo-bladder needs to be looked after well in the sense that the patient may need to learn intermittent self catheterisation. There is an increased chance of urinary tract infection, upper tract dilatation. Given time, there is also a small chance of cancer developing in the new bladder, hence the need for regular surveillance cystoscopy.