RECONSTRUCTIVE UROLOGY

Reconstructive urology includes the surgical procedures that intend to restore the normal functioning of the upper and lower urinary tract and the reproductive organs by repairing, recreating or rerouting them. Patients usually need reconstructive surgery because of injuries, medical conditions, surgeries, birth defects or other treatments. Reconstructive urology is different from other subbranches of urology because it commonly involves open surgery along with sharp skills on general and plastic surgery.

Reconstructive urology treats multiple areas of the human body, however primarily it includes the uterus( the tubes connecting the kidneys to the urinary bladder), kidney, urethra ( the tube leading from the bladder to the exit of the body), bladder, vagina, penis, testicles and prostate gland.

Need for Reconstructive Urology

  • Birth defects in the reproductive organs or urinary tract
  • Erectile dysfunction
  • Bladder fistulas, a condition where the bladder has abnormal openings or connections with nearby organs like rectum or vagina
  • Disorders in the pelvic floor which primarily has three main types: Urinary incontinence or reduced bladder control, fecal incontinence or reduced bowel control and pelvic organ prolapse.
  • Peyronie’s disease is a non-malignant medical condition wherein some fibrous scar tissues develop on the penis leading to painful and curved erections.
  • Prolapse of pelvic organs, a situation where one or more pelvic organs slip from their original position and bulge into the vagina.
  • Traumatising injuries to reproductive organs or urinary tract
  • Neurological diseases like Parkinson’s disease or multiple sclerosis
  • Urethral stricture is a medical condition which involved scarring that narrowed the passage for the flow of urine out of the body.

Treatment under Reconstructive Urology

The study of reconstructive urology has come a long way in the past 20 years. Moving ahead of male genital and scrotal reconstruction and urethroplasty, it now includes reconstruction off bladder and ureter, prosthetic surgery, radiation injuries, tissue engineering, surgery fr urinary incontinence. The prime stay of restructuring urology is to fetch sufficient and viable tissues from locations other than the urinary tract to enable the restructuring of the urinary tract.though its best to use the self harvested tissues of the patient( autologous tissues) from other areas to reconstruct the urinary tract or reproductive organ, there is ongoing research to see if the need for autologous tissues can be eliminated.

  • Ureteric Defects caused by any reason is usually treated by Boari flap, PSOAS hitch, or transureteroureterostomy. In some cases, ureteric replacement with ileum or ureteroureterostomy could also be performed.
  • Augmentation and substitution of the bladder are performed for cases of neurological diseases, tuberculosis or malignancies. It is performed using continent urinary diversion or in some cases using intestinal conduit diversion.
  • Urethral reconstruction is performed using anastomotic and substitution urethroplasty.
  • Fistula repair is conducted to close an opening between the bladder and any other organ
  • Penile surgery is conducted to repair a birth defect called hypospadias in which the urethral opening is on the underside of the penis, rather than on the tip.
  • Surgeries conducted in the vagina to treat pelvic organ prolapse and urinary inconsistence.
  • Buccal mucosa grafting is a complex female genital reconstruction surgery for some intersex state, like for people born with both male and female characteristics. Grafting is done from the cheek’s inner lining.
  • Surgeries for repairing traumatic injuries in the kidneys, penis, testicles and bladder.

Laparoscopy and robot-assisted laparoscopy is aptly and uniquely suited to ureter and bladder reconstruction. It helps to reduce recovery and hospitalisation time. Being an evolving field, experts foresee that reconstruction urology will become far more minimally invasive in the days to come.