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Reconstructive Urology

Reconstructive urology is a challenging subspecialty of the urology, which is concerned with restoration of the normal genitourinary tract (function or structure) which has been disturbed congenitally, by trauma (surgical or otherwise) or by some disease or cancer.

Traumatic injuries are often associated with pelvic fractures (pelvic fracture urethral distraction defect, PFUDD) that can happen as a result of motor vehicle accidents or falls, and can often lead to urethral disruption and urethral stricture.

Dr Bhagat has expertise and extensive experience performing complex reconstructive surgery on the kidney, ureter, bladder, urethra and male genitals. This section is unique because Dr Bhagat has worked with nationally and internationally renowned faculty at high-volume centre (CMC Vellore) with a multidisciplinary approach, combining the expertise and experience of urologists, plastic surgeons and colorectal surgeons.

Congenital urologic conditions:

  • Exstrophy of bladder
  • Epispadias
  • Hypospadias
  • Primary obstructive megaureter
  • Vesicoureteric reflux
  • Pelvic ureteric junction obstruction
  • Undescended testis

Acquired urologic conditions:

  • Urethral disruption injuries from pelvic fracture
  • Recto-urinary fistulas after prostatectomy or pelvic surgery
  • Refractory male urethral strictures
  • Radiation-induced urinary fistulas
  • Major bladder reconstruction – urinary diversion, continent catherizable stomas (Mitrofanoff, Monti), neobladder, augmentation cystoplasty, MACE (antegrade continent enema)
  • Vesicovaginal or ureterovaginal fistulas after pelvic surgery
  • Peyronie’s disease – plaque incision and grafting, penile placation.

Stricture Urethra in 40 yr young gentleman with h/o major abdominal surgery and h/o prolonged urethral catheterization. Underwent multiple EIU and urethral dilation presented with voiding difficulty.

Fig: Ascending urethrogram showing pan-urethral stricture

Harvesting Buccal mucosa for full length Barbagli’s urethroplasty

Mr Amarjeet singh (name changed) 19 yr young boy employed in shipping company. He was trapped between metallic door in submarine and sustained crush fracture of pelvis. He developed retention of urine with urethral bleeding. Underwent emergency surgery for pelvic brim (pelvic girdle) fixation and suprapubic catheterisation. He was not able to pass urine through urethra because of complete disruption at the level of prostatomembranous urethra. He approached me and then after evaluation, the diagnosis of PFUDD (pelvic fracture urethral distraction defect) was made. He underwent successful urethroplasty.

Before Surgery:

After Surgery:

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