At the Center for Reconstructive Urology we have assembled a unique multidisciplinary team approach to genital and urinary tract reconstruction. By collaborating with our colleagues in pediatric urology, plastic surgery, colorectal surgery, orthopedics, and gyn-oncology, we are able to maximize the functional and cosmetic results of our reconstructive surgeries. As reconstructive urologists, we perform quality of life surgeries that relieve patient suffering and often provide transformative benefits for our patients. We are able to do great work because of our unique team approach, and because we each love what we do.
The discipline of reconstructive urology has expanded in the last two decades, well beyond urethroplasty and male genital and scrotal reconstruction. Other important related topics within the realm of GU reconstruction, for both female and male patients, include bladder and ureter reconstruction, urinary fistulas, prosthetic surgery, radiation injuries, tissue engineering, regenerative medicine, surgery for urinary incontinence, and wound healing. Urinary tract reconstruction also includes the advanced surgical techniques using rotational muscle flaps, combined skin and muscles flaps, and skin grafting for genital and soft tissue defect reconstruction. Muscle flaps we commonly employ come from the inner thigh (gracilis muscle), the buttocks (gluteus maximus muscle), the groin (the Sartorius muscle), and the abdomen (the rectus muscle).
Genital reconstruction: If a patient has lost a significant amount of genital tissue due to trauma, burns, or infection, genital reconstruction surgery can help restore the anatomy and minimize scarring. The genitals have traditionally been difficult to reconstruct and commonly require a combination of muscle flaps, skin grafts, or even tissue expander balloons, placed under the skin.
Urinary tract reconstruction entails reconstructing the structures that either store or transport urine – namely the bladder, urethra, and the ureter. Reconstruction of the bladder usually involves augmenting the size of the bladder with a “patch” of small bowel or colon and then bringing the urine to the skin via a surgically constructed channel. When the bladder is completely removed, we can recreate a ‘new’ bladder with 3 feet of small bladder (neo-bladder) or with the right colon and a small segment of small bowel (Indiana pouch). Reconstruction of the urethra entails a combination of skin grafts, oral mucosal grafts, and skin and muscle flaps, to enlarge the urethral diameter – so that voiding can be restored to normal. Reconstruction of the ureter typically entails bridging the gap of missing or diseased ureter, by substituting the ureter with a stretched bladder, a bladder tube, or a segment of small bowel or appendix, to act as a chimney to carry the urine to the bladder. Laparoscopy and robot assisted laparoscopy is uniquely suited for ureter and bladder reconstruction and helps minimize hospitalization and overall recovery time. Laparoscopic reconstruction is an evolving and expanding field, and at Columbia Urology we are committed to using the most cutting-edge surgical techniques. We foresee that most abdominal urinary reconstruction will become more minimally invasive, with time and our growing experience.
Minimally Invasive Reconstruction: Laparoscopic and robotic assisted surgery is uniquely suited for reconstructive urology. The da Vinci® robotic surgical system allows for complex reconstructions to be performed through a series of small 1-2 cm incisions thus minimizing post-operative pain and hastening recovery time. The da Vinci® console delivers 3D magnified high-definition views of the operative field, allowing your surgeon to operate with maximum precision. Increased range of motion of the robotic instruments allows for easy access to areas of the body that can be challenging with open surgery. We have utilized robotic surgery to perform both upper (kidney and ureter) and lower (bladder and urethra) urinary tract reconstruction as well as complex grafting procedures. At Columbia Urology, we are committed to being on the cutting edge of reconstructive surgical techniques. We foresee that most abdominal urinary reconstruction will become more minimally invasive, with time and our growing experience.
Reconstructive urology is an evolving field; many of the procedures we commonly perform today did not exist ten years ago. We embrace innovation and collaboration at Columbia. With a reflective and open mindset, we continually strive to improve and perfect our functional and cosmetic results.