Complex reconstructive surgery aims to restore function to the lower urinary tract (LUT) in patients with congenital or acquired disorders. The success of this type of surgery is dependent upon a sound and comprehensive preoperative evaluation of LUT function based upon urodynamic investigation, endoscopy, and radiological techniques. In addition, it is imperative that the operator is familiar with pelvic anatomy and the abnormalities associated with pathological or iatrogenic insult that are encountered. The application of the surgical tenants applicable to any form of reconstructive surgery is essential, including the excision of ischemic tissue, obliteration of dead space, interposition of vascularized tissue, avoidance of infection and hematoma, and tension-free anastomosis.