Urological reconstructive surgery may be indicated when an anatomical alteration prevents a part of the urinary or genital system from functioning properly and cannot be adequately resolved with more conservative treatments.

Among the main areas of reconstructive surgery are:

• Urethral reconstruction: allows for the repair of a narrowing or injury of the urethra that hinders the passage of urine (urethral stricture). Depending on the location, extent, and previous treatments, different urethral reconstruction techniques (urethroplasty) may be necessary.
• Ureter reconstruction: indicated when a ureter has a narrowing, obstruction, injury, or tissue loss that prevents urine from flowing correctly from the kidney to the bladder. The goal is to restore this passage and protect renal function.
• Bladder and lower urinary tract reconstruction: includes various procedures aimed at recovering or improving the ability to store and expel urine in certain complex alterations. In some cases, it may be necessary to enlarge, repair, or partially reconstruct the bladder or related structures.
• Repair of urinary fistulas: fistulas are abnormal communications between a part of the urinary system and another structure, such as the vagina, intestine, or skin. When surgery is indicated, the goal is to close this communication and restore the normal functioning of the affected structures.
• Reconstruction after surgery or other treatments: some surgical interventions, radiotherapy, or other treatments may cause alterations of the urinary tract that require subsequent reconstruction. The type of surgery will depend on the location and extent of the damage.
• Reconstruction of congenital malformations: some anomalies of the urinary or genital system present from birth may require one or more reconstructive surgeries. The indication and timing of the intervention depend on the type of malformation, its functional impact, and the age of the person. In childhood, this area is specifically developed within pediatric urological surgery.
• Genital reconstructive surgery: certain injuries, malformations, sequelae from treatments or previous surgeries may require procedures aimed at reconstructing genital structures and recovering, when possible, their function. In some cases, the approach requires the coordinated participation of the Reconstructive Urology and Andrology teams. The Foundation includes this collaboration in the approach to complex genital surgery.

Complex urological reconstructions:

Some situations affect multiple segments of the urinary tract, present particularly complex anatomy, or have undergone multiple previous interventions. In these cases, it may be necessary to combine different reconstructive techniques and plan treatment in several stages.

The goal is not only to correct an anatomical alteration but to achieve a reconstruction that offers the best possible functional result in the long term, taking into account aspects such as adequate passage of urine, protection of renal function, bladder function, continence, and quality of life.

How is it performed?

Urological reconstructive surgery encompasses very different procedures, so the preparation, duration of the intervention, type of anesthesia, and recovery vary depending on the structure that needs to be reconstructed and the complexity of each case.

Before the intervention, necessary tests are performed to accurately understand the anatomy and functioning of the urinary tract. Depending on the problem, imaging tests, endoscopic examinations, or functional studies may be necessary. It is also important to know about previous interventions or treatments, as they may condition the planning of the reconstruction.

Different surgical approaches:

Depending on the type of reconstruction, different approaches may be used:

• Open surgery: allows direct access to the area that needs to be reconstructed. It remains necessary in certain reconstructions, especially when they are complex or require the use of grafts or other tissues.
• Endoscopic surgery: allows access to the urinary tract through natural passages, without external incisions. It may be indicated in certain alterations, although it does not always offer a definitive solution and is not suitable for all reconstructions.
• Laparoscopic surgery: allows certain reconstructions to be performed through small incisions in the abdomen, using a camera and specific instruments.
• Robot-assisted surgery: may be used in selected reconstructions of the ureters, bladder, or other structures. The enlarged three-dimensional vision and articulated instruments facilitate dissection and the execution of precise sutures in hard-to-reach spaces. As in any current robotic surgery, the system assists the surgical team but does not make decisions or operate autonomously. Read more about robotic urological surgery.

The choice between these approaches does not depend solely on the complexity of the surgery. The characteristics of the alteration, previous interventions, the state of the tissues, and the needs of each person are evaluated.

After the intervention:

After a reconstruction of the urinary tract, it may be necessary to temporarily maintain a catheter or another drainage system so that urine can flow without interfering with the healing of the reconstructed area.

The time it needs to be maintained varies greatly depending on the intervention. For example, after a urethral reconstruction (urethroplasty), it is common to temporarily maintain a catheter and check that the area has healed adequately before removing it.

Recovery also depends on the procedure. The care team will indicate when physical activity, work, sexual relations, and other daily activities can be gradually resumed.

Long-term follow-up:

The goal of reconstructive surgery is not only to achieve a good recovery after the intervention but to maintain a good functional result over time.

Depending on the reconstruction performed, follow-ups may serve to assess urine passage, bladder emptying and function, continence, or kidney function. Some alterations may reappear over time, so it is important to follow the indicated controls even if there are no symptoms. In the case of urethral reconstructive surgery, for example, European guidelines recommend specific follow-up after the intervention to detect possible recurrences.