Reconstruction
Perhaps the most challenging part of urology is reconstructive surgery. Urethral strictures, loss of the bladder, and various ureteral injuries are serious, debilitating conditions that require the highest level of surgical expertise.
In this section, we describe the available methods for restoring the urethra, bladder, and ureters.
- What is "reconstructive surgery" and how is it related to urology?
- Who is eligible for urological reconstructive procedures?
- To what extent is it possible, and how is ureteral reconstruction performed?
- Is it possible to restore the bladder after its removal?
- What are the modern treatment options for urogenital fistulas?
— What is reconstructive surgery and how is it related to urology?
Strictly speaking, “reconstruction” means restoration or re-creation. In a broad sense, it refers to the re-creation of an organ or the integrity of a structure. In urological practice, there is a wide range of procedures that fall under reconstructive surgery. For example, restoring the patency of the urethra or reconstructing the bladder. Surgical treatment of fistulas—such as excising abnormal connections between the bladder and the vagina—is also considered reconstructive surgery. Essentially, reconstructive surgery aims to improve the patient’s quality of life by restoring the function of a given organ.
— Who is a candidate for urological reconstructive procedures?
- Firstly, these are patients with oncological diseases.For example, during surgery for colon cancer, the surgeon may be forced to remove part of the ureter because the tumor had grown into it. Yes, the patient was cured of a serious cancer, but now has to live with a nephrostomy—a thin tube that drains urine directly from the kidney to the outside. Constantly wearing a special bag to collect urine, monthly nephrostomy replacements, and frequent attacks of pyelonephritis all plunge the patient into severe depression and drastically reduce their quality of life. The same applies to the bladder: during oncological surgeries for colorectal or gynecological cancers, it is sometimes necessary to remove the entire bladder. The oncological surgeon simply has no choice—leaving the cancerous organ is not an option; otherwise, the patient will die. Such patients are candidates for reconstructive surgery of the ureter or bladder.
- Secondly, there are patients with urogenital fistulas. As a result of necessary but aggressive chemotherapy and radiotherapy, for example, for cervical or rectal cancer, fistulas—abnormal connections between the vagina and bladder—can develop.
- Finally, the third group includes patients with urinary incontinence. For example, a patient may have had rectal or prostate cancer. Often, during surgeries for these serious conditions, the nerve and vascular structures responsible for urine retention are damaged. Constant odor, a sensation of wetness, and skin maceration—all of this seriously impairs quality of life.
— To what extent is ureteral reconstruction possible, and how is it performed?
The ureter is essentially a thin tube that carries urine from the kidney to the bladder. Imagine that during an oncological surgery, part of the ureter was removed and a nephrostomy was created. For the patient, this is a terrible ordeal—something no one would wish upon their worst enemy. We offer ureteral reconstruction using several methods: by creating a new tube either from the bladder or from a isolated segment of the intestine.
— Is it possible to restore the bladder after its removal? After all, it’s not the ureter...
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It is entirely possible. When creating "Dilanyan Clinic," we set a challenging goal: to cure the patient of cancer without turning them into a disabled person. If a patient with bladder cancer comes to us and we have to remove the bladder, we usually create a urinary reservoir (made from either the small or large intestine) during the same operation. After surgery, the patient urinates normally.
If the bladder is removed due to other oncological diseases, we offer reconstructive bladder surgery to free the patient from the need to wear two bags for urine collection for life. Again, the patient is able to urinate normally.
— You also mentioned urinary fistulas... What exactly are these fistulas and how can they be treated?
At its simplest, a fistula is an abnormal connection between two hollow organs.
For example, a vesicovaginal fistula is essentially a hole between the bladder and the vagina, while a vesicointestinal fistula connects the bladder and the intestines. This is a terrible nightmare for the patient: after undergoing a major cancer surgery and aggressive chemo- and radiotherapy, everything seems to be fine—the cancer is defeated—but then the fistula appears.
Constant leakage of urine from the vagina, entry of fecal matter into the urinary system, inflammation, and a strong unpleasant odor... The problem is worsened by the fact that fistula treatment is highly specialized surgery requiring experience and skills across several surgical disciplines. That is why we have assembled an interdisciplinary team of top specialists, and why every patient undergoes thorough examination and case discussion at a medical board.
This is how we achieve results: at every stage—whether diagnosis, surgery, recovery, or psychological rehabilitation—we ARE ALWAYS BY THE PATIENT’S SIDE.
