Genitourinary reconstruction is a restorative surgery.
For times when surgery in the pelvic area is necessary, as may be the case with cancerous tissues that need to be removed, the goal is to preserve function and appearance as much as possible. Depending on the reason for surgery, removing tissues and/or part or all of certain structures during the initial surgery may affect reproductive and urinary system processes.
In some cases, the physical appearance of the genitals is affected, either as a result of surgery or because of a preexisting deformity that had to be corrected surgically.
With situations like this, a urologist may recommend genitourinary reconstruction.
Any type of restorative surgery involving structures related to urinary and reproductive functions can be considered genitourinary reconstruction. Structures involved may include the kidneys, ureters, urinary bladder, and urethra. For men, this also includes the prostate gland, testicles, penis, and epididymis. For women, surgery may also involve the vagina, ovaries, uterus, perineum, and fallopian tubes.
When It’s Needed
Genitourinary reconstruction is usually done when tissues in the pelvic or genital area are affected by disease or injury. Such procedures may also be performed if parts of urinary or genital structures have to be removed. In some situations, the reason for reconstructive surgery may be because of vaginal or penile cancer.
Other times, it’s done because of a larger problem that has affected certain structures. For instance, pelvic organ prolapse (POP) in women may dislocate the vagina or seriously damage tissues enough to require some type of surgical restoration.
Fallopian tube reconstruction may be suggested for women with fertility issues. Vasal reconstruction may be an option for men who wish to be able to father a child after having had a vasectomy. Surgery of this nature may also be recommended when:
A significant amount of tissue has to be removed because of scaring in the urethra (urethral strictures)
Urinary fistulas need to be corrected
Congenital or urological conditions are affecting sexual functions
There’s a preexisting abnormality that has to be corrected surgically
How Is It Performed?
The specific way genitourinary reconstruction is performed will depend on what urinary or reproductive structure is affected. Fixation or suspension techniques used following POP surgery, for example, are done through the vagina using the patient’s own tissues. Tissues from other areas of the body may also be used when skin grafts need to be done, as might be the case following the removal or scar tissue from the urethra. With some reconstruction operations, synthetic (laboratory made) tissues, prosthetic devices, or implants may be used. Some male reconstruction procedures may be performed via the area between the anus and scrotum (the perineum).
What Happens After Reconstructive Surgery
After reconstructive surgery, there is a recovery period that usually involves giving tissues time to heal, applying dressings to wound sites, or following special post-surgery instructions, especially with bathing and hygiene habits. With some procedures, physical therapy may be recommended to improve pelvic muscle strength. With reconstruction surgery that involved the bladder, a catheter or external bag may need to be permanently used. When genitourinary reconstruction is successful, patients often seen improvements with urinary and/or sexual functions.
If a structure like the urethra is involved, genitourinary reconstruction is typically performed as a single procedure. When more complex procedures are necessary, reconstruction may be done in phases. Doing so allows tissues to heal between surgeries and minimizes stress on the body. Because of the use of less invasive techniques and new surgical processes like robot-assisted surgery, there are fewer risks associated with many commonly performed reconstruction procedures performed on patients considered good candidates for such operations.