The evaluation begins with a detailed history and physical examination and may include the following :
- Urine culture and sensitivity
- Post-void residual measurement
- CT scan or Cystourethrogram
A few common reconstructive surgeries performed at KIMS are featured below:
A stricture is a region of narrowing in the urethra that is usually made up of scar tissue. Strictures occur much more commonly in men than in women. They may occur congenitally, following trauma to the urethra, or after a severe bout of urethral inflammation such as caused by an infection. Normally, the urethral tube is wide enough to allow an adequate stream of urine to flow through it during urination. When a stricture occurs, the urine stream is noticeably decreased and people may need to strain to urinate or may notice a weak stream, dribbling, or even an inability to urinate. Those who have strictures need to see a urologist who is adept at performing repairs.
A UROLOGIST CAN FIX A BLOCKED URETHRAL OPENING (LUMEN) IN TWO WAYS :
Endoscopically a fiber-optic camera is used to visualize the area of diseased tissue causing a narrowed urethral lumen. The strictured area can be opened by making an incision to widen the lumen. A stent can be used to stretch the lumen open and hold it in the open position. Unfortunately, depending on the location and the length of the strictured area, these methods may not be effective or may not give long-lasting results.
Urethroplasty - A more effective and durable method for repairing most urethral strictures. The scar tissue can be removed by making a small incision at the level of the strictured area. The diseased tissue is replaced with healthy new tissue. In many cases, this healthy tissue is borrowed from the inside of the cheek, this tissue is called buccal mucosa, and it heals very quickly following the procedure. Because people's strictures vary in location and length, operative times for urethroplasties can also vary.
Erectile dysfunction (ED), also called impotency, occurs when a man cannot keep a firm erection during intercourse. ED has many causes including physical disorders such as heart disease, prostate cancer, Peyronnie's disease, and diabetes. Emotional factors such as anxiety, depression, and stress can also lead to impotence. Fortunately, several therapies exist to help one with ED restore a satisfactory erection. Patients should review the alternatives with their urologist so that an appropriate treatment plan can be developed.
Perhaps one of the most reliable solutions to ED is the penile implant, also called an internal pump. The penile implant has several components, all of which are completely unexposed two water-filled cylinders in the penile shaft, a water- balloon reservoir deep in the lower abdomen, and a button in the scrotal sac that allows the patient to inflate and deflate the penile cylinders whenever he wants to have an erection. The procedure, which can be performed under either general or spinal anesthesia, usually requires about 90 minutes of operative time. No catheters are required and patients should refrain from heavy lifting and other exertional activities for 4-6 weeks. For the first six weeks while the tissues are healing, patients are asked not to activate their prosthesis or engage in intercourse. After about six weeks, patients have the device activated for the first time in the urologist's office.
GRAFTS FOR COMPLICATED URETHRAL STRICTURES
When surgeries designed to open up the urethra have failed, we have offered patients innovative solutions. Initially, tissue from the mouth called buccal mucosa can be used to replace the diseased urethral tissue, allowing patients to urinate normally. In cases where this approach has not been successful, we have been the first institution to publish a novel technique called jejunal urethral substitution grafting . In this procedure, urologists and plastic surgeons team-up to harvest a small piece of tissue from the small intestine. This tissue can be used to replace the diseased urethral tissue, allowing patients to urinate normally again.
TREATING MALE ERECTIVE DYSFUNCTION WHEN THE PENILE PROSTHESIS HAS FAILED
When medications and injections are not successful, we can offer patients surgical placement of a penile prosthesis. This implantable device can allow patients to successfully complete intercourse. However, certain erectile dysfunction patients have already failed the penile prosthesis intervention because of erosions and infections. For these individuals, surgical options are generally limited. At our institution urology and plastic surgical subspecialists have collaborated to pioneer the autologous free fibular bone transfer to treat these patients. In this procedure, a portion of the fibular bone, which is not essential for weight bearing, is removed from the lower leg and used to provide penile rigidity for sexual relations. Our initial experience with this procedure has been quite promising, and we feel that this represents a reasonable option for a select group of patients.
TISSUE EXPANDERS FOR GENITAL RECONSTRUCTION
Many patients who present to our combined genitourinary and plastic reconstructive team have suffered significant skin loss overlying their genitourinary organs. This may be due to a variety of problems including necrotizing fasciitis, trauma, or burns. For such patients, reconstructive options can be limited. Penile and scrotal tissues have unique properties, which make grafts from other areas suboptimal. In an effort to reconstruct such patients and restore appropriate cosmetic appearance to the genitalia, we have recently begun using tissue expanders. Tissue expanders allow a patient's own tissue to be expanded, which allows a full and natural reconstruction result.
Sacral neuromodulation, which is also called interstim, acts to provide a small amount of electrical stimulation to the nerves that run through the tailbone (sacrum) to the bladder. For reasons we do not well understand this can improve or eliminated bladder overactivity and urinary leakage from this. Another application of this therapy is for patients that develop urinary retention and cannot urinate effectively. This therapy can be thought of as a bladder pacemaker. The electrical stimulation is usually not something that causes pain or discomfort. KIMS urologic specialists are experts in Sacral neuromodulation.
Procedures to either replace the bladder or help the bladder hold urine are called urinary diversions. Urinary diversion can be as simple as using a small part of the bowel as a tube for the urine to travel in as a conduit to an opening in the skin (an ileal conduit or a urostomy) to something more complex that will hold a larger amount of urine. KIMS urologists can advise you on the best way to deal with bladder problems that might need a urinary diversion. They can also expertly perform these complicated procedures.
Botox has been used to treat urinary incontinence for many years. It acts to decrease the muscular contractions of the bladder. These bladder "spasms" can arise from routine overactive bladder, which commonly occurs in women with aging or they can be more serious in patients with neurogenic bladder from neurologic disease or injury. Bladder spasticity has a lot of different names; it is also called overactive bladder, detrusor overactivity, detrusor hyperreflexia, and neurogenic bladder.
For some patients, surgery may be an option to correct problems that can lead to loss or disease of the genital skin. Our urological specialists are experts in treating and correcting these conditions. Problems that can lead to genital reconstruction surgery may include, Fournier's gangrene, lymphedema, excessive weight gain, and complications caused from injections or ill-advised penile enhancements.