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Urinary leaking. Erectile dysfunction. Difficult or painful urination. Life-changing symptoms that many patients think they’re stuck with after cancer treatment or traumatic injury—or that they’re too embarrassed to bring up. These and other urologic symptoms can often be treated with reconstructive surgery.
Reconstructive urologic surgery can restore normal function after damage or disease of the penis, prostate, scrotum, testes, or urinary tract, which includes the:
- Kidneys, where urine is made
- Ureters, the tubes connecting the kidneys to the bladder
- Bladder, where urine is stored
- Urethra, the tube through which urine exits the body
At MedStar Health, our reconstructive urologists care for patients with sensitive injuries after awful events such as car accidents. Many of our patients have had prostate cancer and either surgery or radiation therapy. Sometimes, this can cause urinary or sexual function symptoms that reduce their quality of life.
With reconstructive surgery, we can rebuild or repair damage, scar tissue, or malformations that interfere with your ability to urinate properly or get or hold an erection. Many patients can regain function and get back important aspects of their lives.
Our full-time reconstructive urologists use the latest technologies, including robotic-assisted surgery, to produce excellent results. Some of the most common conditions we treat with reconstructive surgery are urethral strictures, urinary incontinence and erectile dysfunction (ED).
Urethral strictures or scarring of the urethra due to trauma, infection, radiation and other causes. While radiation therapy is an effective treatment to get rid of microscopic cancer cells that might remain after prostate cancer surgery, it can damage healthy tissue around the prostate, causing scars called strictures in the ureters and urethra.
About 2% of prostate cancer survivors develop strictures within four years of treatment. Symptoms of urethral strictures can include:
- Abdominal pain
- Dark or bloody urine
- Loss of control of the bladder
- Pain upon urination
- Slow or spraying urine stream
- Swelling of the penis
- Urine leaking
Reconstructive urologists can use minimally invasive, robotic-assisted surgery to remove strictures and reopen the ureters and urethra.
When I see patients seeking care for ED, they have usually tried medications such as Viagra or Cialis without success. If these drugs don’t work, you can choose from two general options, one of which is surgery.
Injectable medication: Injectable medicines bypass many of barriers that cause oral medicines (Viagra/Cialis) to fail. The most common injectables for erectile dysfunction are Trimix, Bimix, and papaverine.
In our clinic, a nurse practitioner can teach you how to give yourself the injection. The process involves drawing the medication into a syringe. Then the medicine is injected into specific areas of the penis while avoiding nerves or blood vessels.
While injectables work well for some men, others say the time and focus needed to produce an erection can dampen romantic spontaneity. In such case and others, many men choose surgery.
Penile implant surgery: For some patients, a device placed inside the penis gives them the best chance at achieving a satisfactory erection. These procedures have been around for more than 30 years and are constantly being improved to make the devices simpler to use and more durable.
Penile implants come in two main types:
- Inflatable implants: The most common of the two options, these devices can be filled with fluid from an implanted reservoir to create an erection and deflated when not in use.
- Semirigid rods: These devices are always firm. Implanted under the skin of the penis, the rod can be bent toward a partner for sex or toward the patient’s body for concealment when not in use. Some rods are designed with segments and springs for greater range of motion.
As with any surgery, there are risks including infection, malfunction, or internal erosion, in which the implant wears down the skin on the inside of the penis. In general, our patients are very satisfied with these devices. They are an excellent option for those who have had prostate cancer or other conditions that may make oral medicines unsuccessful.
Other conditions we treat.
If you have symptoms related to your urinary tract, be sure to speak with a urologist. Often, a simple procedure can provide lasting relief.
Other conditions that can require reconstructive urology include:
- Blockages of the kidney or ureter, symptoms of which can move from mild to severe quickly if the blockage goes untreated.
- Hypospadias, a birth defect of the penis in which the opening of the urethra is along the underside of the penis instead of at the tip.
- Pelvic organ prolapse, when the muscles supporting the female reproductive organs become stretched, torn, or weakened, causing sagging or bulging into the vagina.
- Peyronie’s disease, a disorder in which scar tissue builds up in the penis, causing inflammation, swelling, and bending of the penis that makes sex difficult and painful.
My colleagues also specialize in all aspects of gender affirmation, including hormone therapy and affirming bottom surgery to help patients align their bodies with their gender identity.
Robotic-assisted surgery.Robotic-assisted surgical techniques have been an important part of reconstructive urology for the last decade and have become the gold standard for many procedures. Robot-assisted procedures allow us to make very small incisions in the skin, which has several important benefits for patients. These include:
- Faster recovery time
- Less pain
- Lower risk of infection
- Reduced blood loss during surgery
- Reduced scarring due to small incisions
- Shorter hospital stay
Many patients suffer in silence, often for a long time, before getting the right treatment. Urinary problems can be difficult to discuss, but there are excellent treatments available—talk with your doctor about your symptoms. Starting the conversation is the first step to regaining function and enjoying activities that contribute to a fulfilling life.