Urologic reconstructive surgery is defined as the surgical re-routing, recreating, or repairing of the urinary tract. Reconstruction is often needed in patients who have suffered urinary tract injuries, usually from trauma. However, other conditions such as cancer treatments, complications from other surgeries, congenital malformations, and infections can result in the necessity for urologic reconstructive surgery. Yale Urology is committed to helping you through the process starting from a complete understanding of your problem, to offering you all of the options available, to performing the reconstructive surgery. We will work with you and other healthcare providers to ensure that you receive the highest quality care.
The mainstay of reconstructive surgery is obtaining sufficiently viable tissues from non-urinary tract locations on the body to help with the urinary tract reconstruction. While it is best to use the patient’s own tissues (autologous tissues) harvested from other areas to help reconstruct the urinary tract, there is ongoing research to remove the need for autologous tissues. While currently there are no commercially available laboratory regenerated tissue products that can be used, investigators in the field continue to work on tissue engineering to discover an ideal substitute for autologous tissues.
Reconstructive Surgery and Trauma Explained
The urinary tract is comprised of the “upper” urinary tract which includes the renal pelvis and ureter. The “lower” urinary tract includes the bladder and urethra. Renal pelvis blockage is reconstruction is called a pyeloplasty and of all the urologic reconstructive techniques, a pyeloplasty is one that is least complex. Ureteral injuries and blockages, depending on the location, may be simple or complex requiring additional tissue from either bowel or bladder to supplant the loss ureteral tissue.
Bladder reconstruction is usually performed on a bladder that cannot hold sufficient volume of urine (or has too high of a pressure). A bladder needs to be reconstructed usually due to a neurogenic bladder (see Section on Neurogenic Bladder). Bladders are most commonly reconstructed with autologous bowel tissue. At times if the bladder is not reconstructable, or needs to be removed, the urine (coming from the kidneys through the ureters) will need to be diverted out of the body through one of 3 reconstructive methods: 1. a segment of bowel used as a conduit to carry the urine to the skin of the abdomen, resulting in a stoma and needing to wear a bag; 2. a segment of bowel is reconstructed into a spherical “neobladder” to hold urine which is then connected either to the urethra (patient will hold urine in the pouch until time the patient urinates the urine out of the pouch through the urethra – no bags are needed) or the skin (a patient will hold urine in the pouch and d intermittently catheterize the pouch with a rubber tube – no bags are needed).
Urethral injuries, which almost always occur only in males because of the length of the urethra, result in urethral blockages. Other causes of urethral blockages, besides injuries, are urinary tract infections. Once again, even with urethral strictures from infections, it is almost exclusively males who develop urethral strictures from infections as it is very rare for females to get urethral strictures. Management of these injuries can be complex and depends on the individual case and the surgeon's expertise. The anatomy of the urethral stricture (i.e. length and location) must be thoroughly studied and an appropriate treatment plan developed. Treatments can include removing the portion of the strictured urethra and reconnecting the urethra or replacing a small segment of urethra with tissue from another area of the body. Factors that affect this decision include the exact length and location of the strictures.