Rigi10™ Malleable Penile Prosthesis
Also Known As
Urinary diversion, urinary tract diversion, urinary system reconstruction, lower urinary tract reconstruction, urinary reconstruction, neobladder reconstruction, orthotopic neobladder reconstruction, urethral reconstruction, bladder augmentation, continent urinary diversion, incontinent urinary diversion
Definition
Urinary tract reconstruction refers to a group of surgical procedures designed to repair or rebuild parts of the urinary tract that are damaged or not functioning properly.1 These procedures involve modifying, replacing, or rerouting components of the urinary system to restore proper urine flow and storage.2 The reconstructive techniques may include using segments of the patient’s intestines to create new structures such as a neobladder, urinary conduit, or continent reservoir.3 These surgeries are tailored to the unique needs of each individual and aim to preserve renal function, improve quality of life, and prevent serious complications.4
Clinical Context
Urinary tract reconstruction is clinically indicated in various scenarios where the normal urinary pathway is compromised or requires modification.1 The primary conditions necessitating these procedures include:
- Bladder cancer requiring cystectomy (bladder removal)2
- Neurogenic bladder dysfunction from conditions such as spinal cord injury, multiple sclerosis, or spina bifida1
- Congenital anomalies affecting the urinary tract2
- Trauma to the urinary system, including pelvic fracture urethral injuries3
- Radiation damage to the bladder from cancer treatment2
- Chronic inflammatory conditions affecting bladder function2
- Severe urinary incontinence unresponsive to other treatments2
- Urethral strictures caused by trauma, infections, or previous surgeries4
Patient selection criteria include comprehensive evaluation of renal function, urodynamic studies, and assessment of manual dexterity and cognitive ability (particularly for continent diversions requiring self-catheterization).1
The surgical approach varies based on the specific anatomical defect and patient factors. Major reconstruction types include:
- Incontinent urinary diversion (ileal conduit): Ureters are connected to a segment of intestine that is brought to the skin surface as a stoma, with urine continuously draining into an external collection bag.3
- Continent urinary diversion (Indiana pouch): An internal reservoir is created from intestinal segments, with a valve mechanism allowing storage of urine and periodic drainage via catheterization through a small stoma.3
- Orthotopic neobladder reconstruction: A new bladder is created from intestinal tissue and connected to the urethra, allowing for more natural voiding.2
- Urethral reconstruction (urethroplasty): Repair of the urethra using various techniques including tissue grafts or flaps, with success rates of 90-95% for appropriate candidates.4
Expected outcomes include preservation of renal function, improved quality of life, and prevention of serious complications.1 Recovery typically involves hospitalization for 3-5 days, followed by a period of adaptation as the reconstructed system begins functioning.2 Potential complications include urinary tract infections, stone formation, metabolic disturbances, and incontinence.1 Long-term follow-up is essential to monitor these potential issues and ensure continued proper function of the reconstruction.1