Effective Surgical Options for Recurrent Urinary Tract Infections

Urinary Tract Infections (UTIs) are common infections that can affect any part of the urinary system, including the bladder, kidneys, ureters, and urethra. While most UTIs are treatable with antibiotics or non antibiotic approach which is the modern way, some cases may require surgical intervention to address underlying issues or complications.

What Are the Common Surgical Procedures for UTIs?

1. Urethral Dilation

Purpose: Urethral dilation is used to widen a narrowed or scarred urethra, which can result from recurrent UTIs or conditions like urethral stricture (narrowing of the urethra).

Procedure: A urologist inserts a series of progressively larger dilators into the urethra to stretch and widen it. This helps improve urine flow and reduces the risk of recurrent infections.

2. Cystoscopy

Purpose: Cystoscopy is a minimally invasive procedure to visualize the inside of the bladder and urethra, helping identify abnormalities or sources of infection.

Procedure: A thin, flexible tube with a camera (cystoscope) is inserted into the urethra and advanced into the bladder. The urologist examines the bladder lining and urethra for signs of infection, inflammation, or structural issues.

3. Lithotripsy

Purpose: Lithotripsy is used to break up kidney stones (renal calculi) into smaller fragments that can be passed more easily through the urinary tract.

Procedure:

• Extracorporeal Shock Wave Lithotripsy (ESWL): This is the most common type of lithotripsy. It uses shock waves generated outside the body to fragment kidney stones. The fragmented stones can then be passed out of the body through urine.
• Laser Stone Fragmentation: Under general anaesthesia (GA), laser lithotripsy is performed using a ureteroscope (a thin tube with a camera) inserted through the urethra and bladder into the ureter. The laser energy is used to break the stones into smaller pieces, which can then be removed or passed naturally.

4. Surgical Correction of Anatomical Abnormalities

Purpose: Structural abnormalities of the urinary tract, such as ureteral strictures (narrowing of the ureters) or vesicoureteral reflux (backflow of urine from the bladder to the kidneys), can predispose individuals to recurrent UTIs.

Procedure: Surgical correction may involve procedures like ureteral reimplantation (reattaching the ureter to the bladder) or bladder reconstruction to prevent recurrent infections and preserve urinary function.

5. Treatment of Enlarged Prostate

Purpose: An enlarged prostate (benign prostatic hyperplasia, or BPH) can cause incomplete bladder emptying, leading to stagnant urine and increasing the risk of UTIs.

Procedure: Various surgical options are available to treat BPH, including:

• Transurethral Resection of the Prostate (TURP): This is the most common procedure, where a portion of the prostate is removed to improve urine flow.
• Laser Therapy: Laser energy is used to remove or shrink prostate tissue.
• UroLift: A minimally invasive procedure that lifts and holds the enlarged prostate tissue out of the way, so it no longer blocks the urethra.
• Rezum: Uses water vapor therapy to destroy excess prostate tissue, reducing its size and alleviating symptoms.
• Optilume: A novel approach that combines drug-coated balloon dilation with the delivery of an anti-proliferative drug to treat urethral strictures.
• iTIND (Temporary Implantable Nitinol Device): Temporarily placed in the prostate, it reshapes the urethra, improving urine flow without permanent implants.
• Aquablation: Utilizes high-velocity water jets to remove prostate tissue precisely, offering a minimally invasive option with reduced side effects.

Who Might Benefit from Surgery for UTIs?

Surgery for UTIs may be recommended for individuals who experience:

• Recurrent UTIs that do not respond to conservative treatments, such as antibiotics and lifestyle modifications.
• Structural abnormalities of the urinary tract, like urethral strictures, bladder diverticula (pouches in the bladder wall), or kidney stones, that contribute to recurrent infections or urinary symptoms.
• Complications of UTIs, such as abscesses (pus-filled pockets), fistulas (abnormal connections between organs), or urinary obstructions that require surgical intervention to resolve.
• Enlarged prostate causing incomplete bladder emptying, leading to stagnant urine and recurrent UTIs.

What Are the Risks and Benefits of Surgery for UTIs?

Risks

As with any surgical procedure, surgery for UTIs carries certain risks, including:

• Infection: Postoperative infections can occur at the surgical site.
• Bleeding: There may be bleeding during or after surgery.
• Injury to surrounding organs or tissues: Nearby organs or tissues can be accidentally damaged.
• Adverse reactions to anaesthesia: Some patients may experience negative reactions to anaesthesia.

Additionally, there is a risk of recurrence of UTIs or the development of new urinary symptoms following surgery, especially if underlying risk factors are not adequately addressed.

Benefits

Surgery for UTIs can provide several benefits, including:

• Symptom relief: Alleviating pain, discomfort, and urinary symptoms.
• Prevention of complications: Reducing the risk of severe complications like kidney damage.
• Improved urinary function: Enhancing the overall function of the urinary system.
• Reduced need for long-term antibiotics: Decreasing the reliance on antibiotics for chronic UTIs.

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Words of Wisdom from a Consultant Urologist

Addressing the root cause of recurrent UTIs through appropriate surgical interventions can significantly enhance a patient's quality of life. It's essential to evaluate each case individually and consider surgery when conservative treatments fail to provide relief or when anatomical abnormalities are identified.

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