Principles of reconstructive urology

Here we give a brief overview of the development of reconstructive urology and of the types of clinical conditions for which it is appropriate. We introduce the fundamental surgical approaches to the repair or replacement of the ureter, bladder, and urethra and describe the anatomical and pathophysiological principles of the use of grafts and flaps of various types to achieve these goals – concentrating particularly on oral mucosal grafts and skin flaps for the urethra, intestinal flaps for the bladder and ‘bridging’ techniques for the ureter. The general principles of reconstructing the ureter or urethra are similar. One either finds a way of bridging a gap between the two ends of healthy ureter or urethra on either side of the area of pathology, or finds a way of replacing the affected segment, or of augmenting its calibre if part of the circumference is healthy enough for it to be worth preserving.