“Reconstructive urology corrects obstructions of the urinary tract”

Dr. Angel Roncalés answers questions about reconstructive urological surgery, which is the sum of surgical procedures aimed at correcting different types of urinary tract obstruction, as well as replacing, modifying or bypassing urine conduction. All of this has the ultimate goal of preserving renal function.

What is reconstructive urology?

Reconstructive urological surgery can be defined as the sum of surgical procedures aimed at correcting different types of obstruction of the urinary tract, and to replace, modify or bypass the conduction of urine, all with the ultimate goal of preserving renal function.

What are the problems it treats?

On the one hand, obstructions (except those secondary to prostatic hypertrophy and/or lithiasis), both of the upper urinary tract and the urethra. On the other hand, any pathology that involves the removal of the bladder or any ureteral segment, mainly due to malignant diseases, in which with the use of the bowel, we are able to reconstruct, redirect or modify the anatomical configuration of the urinary apparatus. In addition to these two groups that I have highlighted, there is a miscellany of surgical procedures in the urogenital and andrological sphere to treat multiple diseases of infectious, malformative, inflammatory, etc. causes.

Could you describe your procedure for us?

Pyelo-ureteral and uretero-vesical plasties can be approached endoscopically and laparoscopically, and occasionally by conventional surgery. To correct urethral strictures, endoscopy is of very limited efficacy, so we usually resort to conventional surgery. Depending on the location and its extension, it is necessary to use flaps and especially grafts, among the best results are those obtained from the buccal mucosa, from the inside of the cheek.

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The use of the intestine allows the substitution of the bladder, in its anatomical location, to maintain urination through the urethra, with voluntary control, reproducing the natural model. If this is not possible, either for anatomical reasons or due to the extension of the neoplastic disease, we use derivative techniques, which conduct the urine through the digestive tract, or to a cutaneous stoma, requiring a collecting bag.

What are the risks involved for the patient?

Apart from the global risks of any surgery, in reconstructive techniques there is always a hypothetical risk of reproduction of the cause that originated the indication, i.e. a new narrowing, or even the recurrence of a tumor that had previously been removed. On the other hand, as the urinary tract is involved, the passage of urine requires the placement of internal or external tubes for its conduction and to avoid as far as possible the appearance of fistulas.

What is the recovery like after this operation?

Sometimes the postoperative period can be long, especially in cases of cystectomy with substitution or transintestinal diversion, aggressive and mutilating surgery to treat the bladder tumor, which is sometimes very aggressive, requiring complementary therapies. During convalescence, the patient is trained to recover the continence mechanism and achieve voluntary control of urination.