Severe bladder dysfunction can develop in someone with neurogenic bladder issues or urethral trauma. These issues are most commonly associated with specific urologic conditions, including pelvic cancer irradiation, sexually transmitted diseases, lichen sclerosus, hypospadias, perineal trauma, urethral strictures and hypospadias surgery.
A person experiencing these conditions may develop scar tissue in their urethra. The inflammation of the scar tissue produces a narrower path in the urethra for the urine. That is what ultimately causes the person to have trouble urinating or painful urination. If the conditions are not treated promptly, they could progressively become worse by causing sexual dysfunction and urinary tract infections.
Severe bladder dysfunction requires the urinary tract to undergo repair in order for these issues to be resolved. Urinary tract reconstruction is the surgical treatment needed to repair the urinary tract and restore its full functionality. The urinary tract holds the urethra, which is responsible for transporting semen and urine to the end of the penis for men and to the upper portion of the vagina in women.
Urinary tract reconstruction repairs all areas of the urinary tract, such as the exit areas of the urethra, the sphincters connecting the bladder to the urethra and the urethra itself. One or more of these areas could be damaged, so the urinary tract reconstruction targets them all to restore their functionality.
Before the urinary tract reconstruction process, the urologist examines the patient to understand their condition fully. They want to know the severity of the condition, the associated symptoms, and the patient’s overall health. Based on this information, the urologist will recommend one of three urinary tract reconstruction procedures. Each procedure is effective and necessary for reversing the symptoms of various urinary tract conditions. The urologist ultimately decides which procedure is the best to repair their patient’s particular urinary tract problem.
Ureteral reconstruction and reimplantation require the urologist to surgically remove the ureter of the patient in order to repair it. After that, the repaired ureter is reimplanted into the same area of the body where it was removed. A patient with ureteral cancer or ureteral trauma will likely need to get ureteral reconstruction and reimplantation. Sometimes a bladder augmentation comes afterwards, depending on the nature of the disease.
If patients have multiple sclerosis, spinal cord injury, or spina bifida, their neurogenic bladder will require a bladder augmentation procedure. The urologist takes portions of the small intestines or colon and uses them as implants to enlarge the bladder size of the patient.
When ureteral reconstruction is performed without reimplantation, the urologist will perform scar tissue removal, stent placement or urethra widening to reduce the symptoms associated with urethral strictures. The repair work can be done without having to reimplant anything.
Lessons to Remember
Severe bladder dysfunction is called “severe” for a reason. Do not procrastinate on seeking treatment because it could lead to a much worse situation in the future. Most patients will fully heal after getting a urinary tract reconstruction procedure done, but the recovery time depends on the severity of the condition and the complexity of the surgery.
The typical patient will remain in the hospital for about seven days after the surgery. They will be forced to use a catheter to urinate until their urinary tract has fully recovered from the procedure. The urologist keeps an eye on the patient’s condition throughout the recovery period to ensure the healing process is working.
The painful and uncomfortable symptoms should decrease as the healing process takes effect. However, if any related symptoms continue to remain, the patient should seek follow-up care from their urologist. The doctor can assist with more embarrassing symptoms, such as erectile dysfunction, and work with the patient until the symptoms are gone.