Urinary tract reconstruction has benefited a vast number of patients with dysfunctional lower urinary tracts caused by congenital abnormalities, previous surgery, or both. Reconstructive efforts have been innovative and continue to evolve. With this evolution, new complications continue to appear, and in order to minimize the risk to the patient, we must recognize our previous lessons. Appropriate patient selection is essential in achieving a successful outcome in this group. The patient's neurologic status, urologic anatomy, renal function, and motivation are also important factors in choosing the appropriate patient and correct surgical approach. Close follow-up remains the single most important element in assuring long-term well-being for most of these patients.