A 35-year-old man presented with poor urine stream with straining to pass urine of 8 years duration. He had a history of repeated Urinary infection. He had been treated with Urethral dilatation and endoscopic urethral surgery elsewhere 3 years ago, which had provided some relief for a few months. He was progressively feeling weak and was breathless at rest.
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On evaluation he was found to have Renal failure with bilateral small dilated kidneys and a thick walled bladder. He was anemic (hemoglobin: 6.7 gm %), had a s. creatinine of 13 mg%. He was dialysed and transfused blood to stabilize him. Further work up established that he had irreversible renal failure and would need a renal transplant. However it was imperative that his lower urinary tract needed to be treated before a transplant could be offered.
Investigations revealed that he had a pan-urethral stricture (narrow urinary passage). Urethroscopy confirmed a very narrow urethral passage. He underwent a reconstruction of the entire urinary passage (peno-bulbar urethra and fossa navicularis) in a single stage using buccal mucosal graft (lining from the both cheek and left upper lip).
With his lower passage reconstructed, he is in a convalescence phase getting ready to undergo renal transplant.
