Reconstructive urological surgery can be defined as the sum of surgical procedures that aim to correct various types of urinary tract obstruction and to replace, modify or divert urinary ducts. Through these operations, it is, therefore, possible to preserve the function of the kidneys.
What are the problems that reconstructive urology deals with?
We must first make a distinction between the obstructions (both of the upper urinary tract and of the urethra) and the pathologies that lead to the removal of the bladder or of a urethral segment (usually these are malignant diseases), which can be reconstructed thanks to the use of parts of the intestine. In fact, two different types of operations are needed to solve these two types of problems. In addition to these two macro-areas, there is also a set of surgical procedures concerning the urogenital and andrological sphere aimed at solving infectious, inflammatory and malformation diseases.
Reconstructive urological surgery can help patients with conditions such as:
- Birth defects in the urinary tract or reproductive organs
- Bladder fistulas (abnormal openings or connections between the bladder and nearby organs, such as the vagina or rectum)
- Erectile dysfunction
- Neurological conditions such as multiple sclerosis or Parkinson’s disease
- Pelvic floor disorders
- Pelvic organ prolapse
- Peyronie’s disease
- Traumatic injuries to the urinary tract or reproductive organs
- Urethral stricture (scar tissue in the urethra that causes narrowing)
- Urinary incontinence
- bladder reconstruction, penile prosthesis implant, reconstructive penile surgery, testicular prosthesis implant, circumcision, and frenuloplasty.
How is urological surgery performed?
The pieloureteroplastica and uretro-bladder plastic surgery are performed through endoscopy and laparoscopy, more rarely through conventional surgery. Depending on the location and extent of the problem it is necessary to introduce grafts. Those that give better results are obtained from the buccal mucosa, which is located inside the cheek.
The use of the intestine makes it possible to replace the bladder, thanks to its anatomical position it is possible to maintain urination through the urethra, with voluntary control, reproducing the natural model. If due to the position or extent of the disease it is not possible to use the intestine, techniques are used with which it is possible to conduct urine through the digestive tract.
What are the risks of urological surgery?
In addition to the typical risks of each surgery, in reconstructive techniques, there is always a minimum risk of reproducing the initial disorder, for example, the return of a tumor that had been eliminated. Moreover, since it is the urinary tract, the passage of urine obliges the placement of internal or external tubes to lead it which avoids the appearance of fistulas.
What are the recovery times?
Sometimes postoperative hospitalization may be prolonged, especially in cases of cystectomy with intestinal replacement or derivation and in those of aggressive surgery to treat bladder cancer, which often requires complementary therapies. During convalescence, the patient is taught to recover the mechanism of continence, in order to be able to control urination again voluntarily.