Urinary Tract Reconstruction

The urinary system may be damaged for various reasons, necessitating reconstructive surgery. Here are some common reasons:

• Trauma: Car accidents, falls, or other forms of physical impact can damage structures of the urinary system (such as the kidneys, ureters, bladder, or urethra).
• Cancer and its treatment: Cancers of the urinary system, such as bladder cancer, kidney cancer, prostate cancer, or urethral cancer, may require surgery to remove part or all of the affected organs. Radiation therapy and chemotherapy may also cause tissue damage, necessitating subsequent reconstructive surgery.
• Congenital disabilities: Some people may be born with abnormalities in the urinary organs, such as bladder exstrophy, abnormal ureters, or congenital urethral stricture, which may require surgical repair.
• Damage from infection: Severe or prolonged infections, such as cystitis or ureteritis, may lead to scar formation, narrowing, or other damage, requiring surgical treatment.
• Urolithiasis: Kidney stones or bladder stones may cause blockages and chronic inflammation, requiring surgery to address the damage or blockage.
• Functional disorders: For example, neurogenic bladder, where nerve damage (such as spinal cord injury or brain lesions) causes bladder dysfunction, may require surgery to restore standard urination mechanisms.
• Tissue damage from diseases: Certain chronic diseases, such as diabetes or vasculitis, may lead to vascular damage, affecting kidney function or the health of other urinary tissues.

Each of these conditions may necessitate one or more reconstructive surgeries to restore the function and structural integrity of the urinary system. When considering options for reconstructive surgery, specialized urologists will conduct detailed diagnoses and assessments to determine the most appropriate treatment.

Urinary tract reconstruction comprises various types of surgery to repair or reconstruct different urinary system parts. These surgical procedures are typically based on the specific injuries or conditions of the patient. Here are some common types of urinary tract reconstruction surgeries:

• Urethral reconstruction surgery: Used to treat urethral strictures or urethral ruptures. The surgery may involve using autologous tissue (such as oral mucosa) for urethral repair or complete urethra reconstruction.
   
• Bladder reconstruction surgery:
  - Bladder augmentation: When the bladder capacity is insufficient or damaged, intestinal segments may be used to expand the bladder.
  - Orthotopic neobladder construction: After the original bladder is removed due to cancer, intestinal tissue creates a new bladder in its original position.
   
• Ureteral reconstruction surgery: Treats damaged or narrowed ureters. Surgery may involve excising the damaged segment of the ureter and reconnecting it or using intestinal segments as a substitute for the ureter.
   
• Pyeloplasty: It is the repair of a blockage between the renal pelvis and the ureter (usually congenital upper ureteral narrowing).
   
• Artificial urinary sphincter implantation: Used to treat severe urinary incontinence, especially stress urinary incontinence. The implanted device helps control the sphincter function of the urethra.
   
• Neuromodulation therapy: For neurogenic bladder, a nerve stimulator is implanted to control the function of the bladder and sphincter muscles, improving autonomous voiding.
   
• Hypospadias repair surgery: For congenital hypospadias, reconstruction and repair of the urethra.