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The goal when treating conditions or abnormalities that may affect the urinary or reproductive organs and structures is to preserve function when possible. If treatment involves removing an organ or related tissues and structures, genital appearance and function can be affected. Since reproductive organs are linked to the urinary system, the ability to process and remove urine from the body can also be altered.
For situations like this, genitourinary reconstruction surgery may be recommended as a follow-up to treatment of the initial problem affecting the urinary or reproductive system.
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If a large amount of tissue in the genital and pelvic area is lost due to disease, infection, sudden trauma, or an existing abnormality that had to be corrected to improve quality of life, there are several reconstructive procedures that may be recommended. With a condition like pelvic organ prolapse (POP), the resulting pressure from misplaced organs may damage the vagina enough to dislocate it or tear tissues that will need to be reconstructed.
Men with genital and lower urinary tract conditions such as urethral strictures or urinary fistulas may need reconstruction surgery following treatment. Cancer that originates or affects the penis and testicles may also lead to a need for reconstructive procedures. Both men and women sometimes develop problems with urinary incontinence or sexual functioning over time due to congenital and urological conditions. Genitourinary reconstruction can involve one or more of the following structures:
The majority of reconstructive procedures performed in the pelvic area involve a combination of skin grafts, oral mucosal grafts, and muscle flaps. With some procedures, tissues from parts of the intestine are used to create new urinary structures. Other procedures involve reconnecting structures in different ways. For example, urethral reconstruction sometimes involves removal of the affected part of the urethra and the reattachment of the remaining part of the tube a the normal ends. Other times, there is a need to create an alternative method to allow urine to exit the body as part of reconstruction surgery.
The specific approach to surgery will depend on where the affected structures are located. Some procedures are performed through an incision in the lower abdomen or pelvic area. In some situations, the affected area may be accessed through the vagina or the area between the scrotum and anus in men. A newer approach to genitourinary reconstruction is to perform surgery with assistance from a robotic device guided by the surgeon's hand movements.
Even when minimally invasive techniques are used, there will be a recovery period that includes limited activities and post-surgery medication to ease discomfort. Some patients benefit from certain types of physical therapy to strengthen pelvic muscles. Results of genitourinary reconstruction will depend on the specific structures affected. For instance, if bladder reconstruction is involved, it may be necessary to use a catheter following the procedure or urinate in a different way.
Due to the complex nature of genitourinary reconstruction, it's sometimes advised to consider having surgery in phases instead of all at once to minimize risks and allow tissues to heal between procedures. Because of possible issues with reproductive functioning following reconstructive surgery, a urologist may suggest egg freezing or pre-surgical sperm preservation for individuals wising to conceive or produce children.
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