Reconstructive urological surgery is a specialized area of urology focused on restoring normal function and anatomy to the urinary tract and genital organs. This type of surgery is often needed to address congenital abnormalities, trauma, cancers, or other conditions that affect the urinary and reproductive systems.
Indications for Reconstructive Urological Surgery
Trauma: Injuries to the urethra, bladder, or kidneys.
Congenital Abnormalities: Conditions like hypospadias, epispadias, and bladder exstrophy.
Cancer Treatment: Reconstruction following surgery for bladder, prostate, or kidney cancer.
Pelvic Organ Prolapse: Surgical correction of prolapsed bladder or urethra.
Strictures and Stenosis: Narrowing of the urethra or other urinary passages.
Fistulas: Abnormal connections between the urinary tract and other organs.
Neurogenic Bladder: Reconstructive procedures to improve bladder function in patients with nerve damage.
Common Reconstructive Procedures
Urethroplasty: Repair or reconstruction of the urethra to treat strictures.
Bladder Augmentation (Cystoplasty): Enlargement of the bladder using tissue from the intestines.
Urinary Diversion: Creating a new way for urine to exit the body, often using intestinal segments.
Ileal Conduit: A piece of the ileum (small intestine) is used to create a passage for urine to an external stoma.
Continent Urinary Reservoir: Internal pouch created from intestinal tissue to store urine, which can be emptied by catheterization.
Bladder Neck Reconstruction: Surgical repair of the bladder neck to improve continence.
Neobladder Construction: Creating a new bladder from intestinal tissue after bladder removal (cystectomy).
Pelvic Organ Prolapse Surgery: Repair of prolapsed organs, such as anterior repair for cystocele or sacrocolpopexy for vaginal prolapse.
Fistula Repair: Closure of abnormal connections, such as vesicovaginal fistulas (between bladder and vagina).
Hypospadias Repair: Correction of urethral opening location in males.
Techniques Used in Reconstructive Urological Surgery
Open Surgery: Traditional approach with larger incisions.
Minimally Invasive Surgery: Includes laparoscopic and robotic-assisted techniques that involve smaller incisions and often result in quicker recovery times.
Endoscopic Procedures: Use of a scope to perform surgeries inside the urinary tract without large incisions.
Preoperative and Postoperative Considerations
Preoperative Evaluation: Detailed assessment including imaging, urodynamic studies, and sometimes biopsy to plan the appropriate surgical approach.
Postoperative Care: Close monitoring for complications, pain management, and gradual return to normal activities. Rehabilitation, including physical therapy and possibly pelvic floor exercises, is often part of the recovery process.
