+49 7071 29-86000

Reconstructive urology & Incontinence

Reconstructive urology is aimed at eliminating morphological or functional disorders of the urogenital tract. Surgeries, accidents, diseases or even childbirth can necessitate the use of reconstructive urology.

Advanced reconstructive techniques, such as free or pedicled tissue transfer, prosthetics, laparoscopic surgery and microsurgery, are used. Among other things, the development of innovative surgical methods, such as latissimus dorsi detrusor myoplasty, has earned our department international recognition in the field of reconstructive urology.

Current scientific projects focus on the use of tissue engineering for reconstruction using tissue produced in the laboratory. Such techniques will also be available in patient care in the foreseeable future.

Possible symptoms & causes

The use of reconstructive surgery may become necessary after surgeries, accidents, diseases or even childbirth.

The symptoms are often not easily recognisable to the patients and may be more or less pronounced:

Kidneys / Ureteropelvic junction obstruction / Ureteral stenosis

The symptoms range from a feeling of pressure in the flank to acute colicky pain, but the condition can also be asymptomatic if it progresses slowly.

(Neurogenic) bladder voiding disorders

Disorders of urine storage in the bladder and bladder voiding may have various causes. Nerves at various locations may have been impaired or changed, which may have various effects on the lower urinary tract.

  • Nerves running from the spinal cord to the lower urinary tract in both directions (peripheral nerves)
  • Changes or problems in the spinal cord or the brain itself (central nervous system, CNS); these include diseases such as multiple sclerosis (MS) and Parkinson’s disease as well as spina bifida (malformation of vertebral bodies) and spinal cord injuries (spinal cord transection)

These include nerve injuries resulting from both surgeries and injuries/accidents in the abdominal area (in the minor pelvis, e.g. rectum, prostate, uterus, etc.).
However, the “abnormal behaviour” of the bladder may also be caused by the bladder itself. This is described by the patients as an urge to urinate or even urge incontinence. (Urge is defined as the need to go to the toilet at too frequent intervals. Urge incontinence is diagnosed if there is also loss of urine before reaching the toilet.)

If no cause can be identified, the condition is referred to as idiopathic, in this case idiopathic overactive bladder (IOAB).

The opposite case is the insufficient voiding of the bladder without the bladder outlet being obstructed. This may be caused by a limitation or loss of the bladder’s contractility (including what is called a non-contractile bladder (“lazy bladder”)). The patient’s ability to urinate is strongly limited or a high volume of residual urine remains in the bladder.

All these changes may influence the urinary bladder and its sphincter in different ways, causing a wide range of different conditions.

Sphincter / Urethra

Sphincter malfunction or dysfunction may be attributed to nerve supply (innervation) and/or muscular factors. Innervation affects all nerves running to and from the respective organ.

In the case of muscular factors, the muscle itself, in this case the sphincter, is affected.

The patient either notices that the urine flow cannot be interrupted or the urine flows out unnoticed and the patient only notices the wet pad/underwear. This is referred to as stress incontinence, which is classified into corresponding grades. Narrowing or insufficient flexibility of the urethra may affect the urine flow. If this is the case, urethrostenosis (urethral stricture) is diagnosed.

This condition usually affects men, because their urethra is longer than that of women. The symptoms often include pain in the urethra below the pelvic floor, accompanied by the feeling that the urethra gets “inflated” above the narrowing (stricture) and that the urinary stream is weak or very thin.

Urethral stricture may also be a consequence of surgeries (e.g. prostate surgery). Possible consequences include anastomotic stricture following radical prostatectomy (for the treatment of prostate cancer) or bladder neck stenosis following the treatment of benign prostatic hyperplasia (BPH).

In addition, urethral stricture may also be caused by injuries or previous infections of the urinary tract.

© Department of Urology Tuebingen - supported by "Förderverein Urologie e. V." - Nonprofit association