Frequently Asked Questions

The ureter is the tube that carries urine from the kidney down to the bladder. A stricture is a narrowed, scarred segment that blocks drainage; a UPJ (ureteropelvic junction) obstruction is a blockage where the kidney meets the ureter. When urine cannot drain freely, it can cause flank pain, recurrent infections, or gradual loss of kidney function. Many patients are managed for years with a stent or a nephrostomy tube before reconstruction is considered. A plain-language patient video on ureteral reconstruction options is available on YouTube.

These tubes are tools used to keep urine draining while a problem is being evaluated, treated, or allowed to heal. A ureteral stent sits inside the body between the kidney and bladder. A nephrostomy tube drains the kidney through the back into a bag. A catheter drains the bladder, and surgical drains may be used briefly after an operation. They can be uncomfortable and inconvenient, but they often provide important information about timing and possible reconstruction options.

Seek urgent medical attention if you have fever or chills, severe or worsening flank or abdominal pain, vomiting, confusion, inability to urinate, a catheter or nephrostomy tube that stops draining, a tube that falls out, heavy bleeding, or if you feel seriously ill. If you recently had surgery, follow the discharge instructions from your care team; if you cannot reach the team promptly or symptoms feel severe, go to an emergency department or call emergency services.

It is a reconstructive technique that repairs a narrowed ureter using a small graft of tissue taken from the inside of the cheek (buccal mucosa) — the same type of lining the urinary tract is comfortable with. Performed with the surgical robot, it can rebuild long or difficult strictures through small incisions. For some patients it may be considered instead of more extensive operations. Whether it is appropriate depends on the location and length of the stricture and your individual anatomy. A patient video about ureteral reconstruction options is available on YouTube, and surgeon-facing videos are available in the video library.

The urethra is the channel that carries urine out of the body. A urethral stricture is a scarred, narrowed segment that weakens the urinary stream, makes emptying difficult, or causes infections. Repeated dilations or internal incisions often provide only temporary relief. Urethroplasty — open surgical reconstruction, sometimes using a graft — may provide a more durable repair for many patients. The approach is tailored to where the narrowing is, what caused it, and what treatments have already been tried. There is a patient video comparing Optilume and urethroplasty on YouTube.

A fistula is an abnormal connection between the urinary tract and another structure — for example, between the bladder and the vagina (vesicovaginal), or between the urinary tract and the bowel or skin. Fistulas can follow surgery, childbirth, radiation, or inflammation, and they often cause continuous leakage of urine. They are repaired surgically by separating the structures and rebuilding healthy tissue between them; the best approach depends on the cause, the location, and whether radiation was involved.

A vesicovaginal fistula is an abnormal connection between the bladder and vagina. A ureterovaginal fistula involves the ureter, the tube that drains the kidney. Both can cause persistent urine leakage and may occur after pelvic surgery, radiation, difficult childbirth, injury, or inflammation. Repair planning depends on the exact location of the fistula, the health of the surrounding tissue, and whether the kidney and ureter are draining safely.

A ureteroenteric stricture is a narrowing where a ureter has been connected to bowel, often after bladder removal with an ileal conduit, neobladder, or other urinary diversion. It can block kidney drainage and may lead to infections, pain, or kidney-function changes. Evaluation usually requires reviewing the original surgery, current imaging, and any tubes or stents already in place.

Yes. Pelvic radiation can cause scarring, poor tissue healing, bleeding, strictures, fistulas, or bladder problems months or years later. Reconstruction in radiated tissue can be more complicated, so planning often focuses on tissue quality, kidney drainage, infection control, and choosing an approach that is realistic for the individual situation.

In selected patients with severe radiation injury, the local tissues around the urethra may be too scarred or poorly supplied with blood for a standard repair to heal reliably. A free flap brings in healthy tissue with its own blood supply, sometimes using a short segment of small intestine called ileum, to help rebuild or replace the damaged area. The blood vessels are reconnected under a microscope so the tissue can stay healthy in its new location. This is complex salvage reconstruction and usually requires careful planning with imaging, scopes, and a multidisciplinary surgical team. Recovery may involve a hospital stay, catheters, drains, stents, and follow-up over weeks to months. Possible issues include infection, poor healing, bowel-related problems, leakage or narrowing at the repair site, and the possibility of additional procedures. Whether this is a reasonable option depends on the exact anatomy, prior radiation and surgeries, tissue quality, and the goals of reconstruction.

Patients with an ileal conduit, neobladder, catheterizable pouch, or other urinary diversion may develop blockage, leakage, recurrent infections, stones, pouch emptying problems, or strictures where the ureters connect. These problems are highly individual, so the office will usually ask for prior operative notes and the actual imaging before a meaningful plan can be discussed. There is also a patient video on urinary diversion options.

Cystectomy means removal of the bladder. It is most often done for bladder cancer, but it may also be considered for selected patients with a very small contracted bladder, severe radiation damage, or fistulas between the bladder and other pelvic organs. When the bladder is removed, the ureters — the tubes that drain urine from the kidneys — must be connected to a new way for urine to leave the body. That new drainage system is called a urinary diversion.

Urinary diversions are often described as incontinent or continent: • Ileal conduit — a short segment of small intestine is used to create a stoma, usually on the right lower abdomen. Urine drains continuously into an external pouch. This is the most common type of urinary diversion. • Neobladder — a portion of intestine is reshaped into a bladder-like pouch and connected to the urethra or another exit point. It is designed so urine can be stored internally, without an external appliance. • Continent catheterizable pouch — examples include T pouch, Kock pouch, or Indiana pouch. A reservoir is made from intestine, and the patient empties it by passing a catheter through a small opening in the abdomen. The best option depends on the reason for surgery, kidney function, bowel history, anatomy, prior radiation or operations, and what the patient can safely manage after surgery.

Recovery depends on the operation and the patient's overall health, but many patients spend about five to seven days in the hospital after cystectomy and urinary diversion. Walking is encouraged early, and physical therapy may help with safe movement. Depending on the diversion, patients may have a catheter, drains, and small temporary stents that help the ureter connections heal. The bowels often take a few days to wake up, so diet may be limited at first. If a stoma is created, an ostomy nurse teaches pouch care and helps choose a pouching system that fits the patient's anatomy. After discharge, activity is usually limited for several weeks to reduce hernia risk. Stents are often removed a few weeks after surgery, and follow-up kidney imaging may be ordered afterward to check for swelling. Your team will give instructions specific to your diversion and recovery.

A bladder neck contracture is scar tissue at the outlet of the bladder, often after prostate or bladder surgery. It can cause a weak stream, difficulty emptying, infections, or urinary retention. Some contractures can be managed endoscopically; others, especially recurrent or complex cases, may need a reconstructive discussion.

A major pelvic fracture can injure or separate the urethra, sometimes leaving a scarred gap after the trauma has healed. Patients may have a suprapubic tube, difficulty urinating, or a completely blocked urethra. Repair planning depends on the injury pattern, prior procedures, imaging, bladder function, and timing after the original trauma. There is a patient video overview of urinary tract injuries and warning signs on YouTube.

This FAQ is focused on urinary-tract reconstruction. Patients seeking primary gender-affirming surgery should start with NYU Langone's plastic surgery team. A helpful starting point is Rachel Bluebond-Langner, MD.

Sometimes. This practice frequently evaluates complex, redo reconstruction — patients who have already had one or more operations that scarred, narrowed, or failed. These cases are more difficult, and a careful review of your imaging and prior operative notes is the first step in understanding what options may still be available.

Second opinions are welcome and common here. In some cases there may be a reconstructive option to consider instead of removing the kidney; in others, removal may be the most appropriate choice. The next step is a careful review of your imaging and history. Gathering your records (below) helps make that review more useful.

Patients often reach out when they have been living with tubes or stents, have had prior repairs that did not hold up, have been told that options are limited, or need help weighing a major operation. A second opinion does not always mean more surgery. Sometimes it confirms the current plan; sometimes it identifies a reconstructive option; and sometimes it helps patients understand the tradeoffs more clearly.

These cases often involve scar tissue, radiation, prior surgery, altered anatomy, or kidneys that have been blocked for a long time. The first step is usually not choosing an operation, but understanding the anatomy: where urine is blocked or leaking, how well the kidney or bladder is working, and what tissue is healthy enough to use for repair.

Yes. A significant share of these reconstructive cases come from out of state and from other countries. The usual path is to send your records first so your case can be reviewed, then arrange a consultation — often by video to start — before you commit to traveling. International patients can also review NYU Langone's International Patient Services.

Dr. Zhao's reconstructive practice generally does not start new-patient evaluations with an in-person office visit. Most out-of-state patients begin with record review and a telephone call, or with a video visit when that is appropriate and available. The first step is deciding whether your problem appears to be something that may be treatable with reconstructive surgery. If so, the team will discuss the next step. It is not unusual for patients traveling to New York for surgery to meet Dr. Zhao in person for the first time in the preoperative area. The actual surgery includes an in-person evaluation in the preoperative area, after the records, imaging, plan, and logistics have already been reviewed.

In many cases, yes — a video visit is a practical way to review your imaging and discuss options before traveling. Because of state medical-licensing rules, the type of visit that can be offered may depend on where you are physically located. The actual surgery includes an in-person evaluation in the preoperative area. The scheduling team will tell you what is possible for your situation when you reach out.

The most useful items are: • Imaging — CT urogram, MRI, retrograde/antegrade studies, or ultrasounds. The actual images matter, not just the reports; for many patients, asking the imaging center for CDs is still the simplest way to get a complete copy. • Operative notes from any prior urinary-tract surgeries. • Procedure and cystoscopy reports, including stent or tube changes. • A brief timeline of your symptoms and treatments, plus recent kidney-function labs. Having these ready before your first call makes the review more useful. Contact the office and speak with the scheduling team about the best way to submit records for your case.

It varies by procedure and by how far you've traveled. For many major reconstructions, a practical starting point is to plan to stay in New York for about two weeks after hospital discharge, in addition to any pre-operative visit and the hospital stay itself. Some patients need more or less time depending on the operation, tubes or catheters, and recovery. The team will give you a specific plan for your situation.

Most traveling patients need planned follow-up after reconstruction, often including some follow-up imaging. After the immediate post-operative period, many patients do not need to return to New York in person unless the team specifically recommends it. General urology issues, ongoing urinary symptoms, recurrent infections, or non-surgical concerns are usually followed close to home by your urologist, primary care doctor, or an infectious disease specialist when appropriate.

Having a family member or friend with you is beneficial, especially during the first days after discharge. You will need a responsible adult to pick you up after surgery and help you get safely to where you are staying. The team can tell you what level of help is expected for your specific procedure.

Dr. Zhao sees patients in clinic at NYU Langone Urology Associates, 222 East 41st Street, 11th Floor, New York, NY 10017. Surgery is commonly performed at Tisch Hospital. Much of the reconstructive practice is handled by telephone calls and virtual visits when possible, especially for patients who live far away, to reduce the burden of traveling to New York. Your actual appointment and surgery details will be confirmed by NYU Langone.

There are many hotels within easy reach of the medical center, at a range of price points, and the office can point you toward options that other traveling patients have used. Choose lodging close by for the days right after surgery so follow-up visits are simple.

Many procedures are covered by insurance, but coverage, in-network status, and out-of-pocket costs depend on your specific plan. Out-of-network, self-pay, and international patients are handled case by case. The office and the hospital's financial team can help you understand benefits and, where relevant, provide cost estimates before surgery. This page can't quote prices — please verify the details directly with your insurer and the office. International patients can also contact NYU Langone International Patient Services.

This is an academic practice, so you'll be cared for by a team. Alongside Dr. Zhao, that typically includes a reconstructive urology fellow (a fully trained urologist completing advanced subspecialty training) and advanced practice providers — nurse practitioners and physician assistants — who help coordinate your care, answer questions, and manage follow-up. In the hospital, urology residents are also part of the care team and help with inpatient care under supervision. In practice this gives patients more than one point of contact as questions come up.

Yes. Dr. Zhao is the operating surgeon for your reconstruction. As at any teaching hospital, fellows and residents participate in care under his direct supervision — which is part of how complex reconstructive technique is taught and advanced.

Most non-urgent questions are handled through the office line and the patient portal (MyChart), where the advanced practice providers and coordinator can respond and, when needed, bring questions to Dr. Zhao. For anything urgent after surgery, you'll be given specific instructions on who to call and when. Scheduling and contact details are in the next section.

Gather your imaging and prior operative notes first (see "What records should I gather"), then contact the office and ask the scheduling team how to submit the records for review. Having complete records ready is one of the most helpful ways to make the review productive — especially for complex or redo cases.

There are several physicians with the same or similar last name, and scheduling requests can occasionally be routed to the wrong person or the wrong type of appointment. If you are trying to schedule specifically for reconstructive urology with Lee C. Zhao, MD and are having trouble getting on the schedule, you can email ReconstructiveUrology@nyulangone.org.

Patient-facing videos are available directly on YouTube, including urethral stricture options, ureteral reconstruction, urinary diversion, and urinary tract injuries. Surgical education videos remain organized at video.leezhaomd.org.