What Is a Reconstructive Urologist?
A reconstructive urologist is a urologist who has completed additional fellowship training (typically 1–2 years) focused on rebuilding and restoring the structure and function of the urinary tract. These specialists are experts in urethral stricture repair, male incontinence surgery, complex urinary reconstruction, and gender-affirming urologic surgery. Fellowship training is sponsored by the Society of Genitourinary Reconstructive Surgeons (SGURS), which currently has approximately 20 fellowship programs.
What Conditions Does a Reconstructive Urologist Treat?
- Urethral stricture — scar tissue narrowing the urethra, causing difficulty urinating (anterior, posterior, or recurrent strictures)
- Male urinary incontinence — leaking urine after prostate surgery or radiation treatment
- Bladder neck contracture — scarring at the bladder outlet after surgery
- Ureteral stricture — narrowing of the tube between the kidney and bladder
- Complex urinary diversion problems — complications from prior bladder removal surgery
- Bladder augmentation — surgically enlarging a small or poorly functioning bladder
- Fistula repair — abnormal connections between the urinary tract and other organs
- Lichen sclerosus with urethral involvement — a skin condition that can cause severe urethral scarring
- Gender-affirming urologic surgery — vaginoplasty, phalloplasty, metoidioplasty, and related procedures
What Procedures Does a Reconstructive Urologist Perform?
Reconstructive urologists perform urethroplasty (open surgical repair of urethral strictures using various techniques including buccal graft), artificial urinary sphincter (AUS) implantation for male incontinence, male sling procedures (AdVance, Virtue), bladder neck reconstruction, ureteral reconstruction (Boari flap, psoas hitch, transureteroureterostomy), ileal ureter replacement, bladder augmentation, Mitrofanoff appendicovesicostomy (creating a catheterizable channel), renal autotransplantation, sacral neuromodulation (InterStim), and gender-affirming surgeries (vaginoplasty, phalloplasty, metoidioplasty, scrotoplasty, urethral lengthening).
Who Should See a Reconstructive Urologist?
Patients with urethral stricture disease, men leaking urine after prostate cancer treatment, patients with complex urinary tract reconstruction needs, patients with complications from prior urologic surgery, and individuals seeking gender-affirming urologic surgery should consider seeing a reconstructive urologist.