Reconstructive Urology

Reconstructive urology is surgery to restore normal urinary or sexual function by repairing, rerouting, or recreating areas of the upper and lower urinary tract and some reproductive organs. Dysfunction or damage in the urinary tract can be caused by many things, including trauma/injury, congenital disorders (birth defects), kidney stones, and radiation or surgery for cancer. Patients may experience urine leakage (incontinence), urine blockage, or abnormal connections between organs that greatly reduce quality of life.

Surgeons should have extensive expertise in performing complex reconstructive surgery on the kidney, ureter, bladder, urethra and male genitals. Some of the Common Reconstructive Surgery Procedures include:

• Repair of Hypospadias (congenital deformity of the urethra)
• Urethroplasty or Optical Internal Urethrotomy (OIU) for stricture urethra
• Augmentation Cystoplasty (increasing the size of urinary bladder)
• Neobladder formation (forming new bladder using intestine)
• Boari’s Flap of bladder or Psoas Hitch of bladder (to reconstruct lower ureter)
• Ileal replacement of ureter (Using intestine to reconstruct the upper ureter)
• Pyeloplasty (for PUJ obstruction)
• Endopyelotomy (for PUJ obstruction)

There are different types of Reconstructive Urology Treatment:

Urethroplasties :

Urethroplasty is a surgery in which the urethra is reconstructed to cure problems like urethral strictures. The types of surgeries are varied and depend upon the location, cause, and length of the stricture. Most surgical procedures take between three to six hours to complete. Urethroplasty is an open surgical reconstruction or replacement of the urethra that has been narrowed by scar tissue and spongiofibrosis (urethral stricture). Urethroplasty is the gold standard for urethal reconstruction with the best and most durable results. Urethroplasty is a surgical procedure where the urethra is reconstructed to treat various stricture problems. It is performed to remove the narrowed phase of the urethra or to enlarge it. The procedure may also involve reconstruction of the surrounding tissues.

VVF Repair :

VVF means Vesico Vaginal Fistula. Fistula means connection between two organs due to creation of hole in the organ. VVF happens because of communication between bladder & vagina. A whole occurs in bladder as well as in vagina. Cause of VVF is difficult hysterectomy executed for uterine fibroid, Dysfunctional menstrual bleeding and other uterine condition because of improper exposure or intense bleeding trauma may occur to bladder wall. Due to trauma a part of the bladder wall will become a vascular and eventually it creates fistula with Vagina. In periphery at village hospitals VVF is common due to obstructured labour or forcep delivery. In obstructed labour there is compression of triagonal area among pubic bone and fetus head which couses a vascular necrosis of trigonal which ultimately give rise to VVF.

Pyeloplasties :

Pyeloplasty is a kidney surgery that removes the offending obstruction that is stopping the natural flow of urine out of the body and repairs any damage that has occurred because of excessive fluid pressures deforming the kidney. It is the surgical reconstruction of the renal pelvis. The renal pelvis is a part of the kidney. Pyeloplasty is performed to drain and decompress the kidney. Almost all cases are to relieve a ureteropelvic junction obstruction or shortly known as UPJ obstruction. Just the tissues in which the ureter is obstructed is cut, and the original ureter is repositioned and attached back to the healthy renal pelvic tissue above.