Reconstructive and Prosthetic Urology

Urethral stricture

Though often unrecognized by patients, symptoms of urethral stricture are commonly difficulties or irregularities while urinating. This may include a slow prolonged urinary stream, straining to urinate or a feeling of your bladder completely emptying. It is important to diagnose a stricture to determine the best treatment option.

Typically, a cystoscopy procedure in the office will diagnose a stricture, and an imaging study called a retrograde urethrogram will help characterize any strictures or other abnormalities in the urethra. Once the diagnosis and evaluation are complete, your physician will discuss treatment options.

Penile implants for treatment of Erectile Dysfunction

Medical therapy for Erectile Dysfunction (ED) has improved tremendously, but some men find medication and/or all non-surgical options ineffective in achieving satisfactory erections. In these cases, penile implant surgery is a treatment option. This procedure involves the placement of an internal device, called a “penile prosthesis,” that restores your ability to have erections and sexual intercourse.

Your specialist physician will have a detailed discussion with you regarding your individual goals for what you want to achieve with therapy for ED, and review all options to optimize and restore your sexual quality of life.

Peyronie’s Disease

Every man’s anatomy is different from size and shape to possibly having a slight curve. But if you notice a significant bend has formed when your penis is erect, or if you notice narrowing of the penile shaft, it’s time to discuss the possibility of Peyronie’s disease with your urologist.

A curved erection caused by Peyronie’s disease may happen because of a problem in the way the body heals after an injury (a connective tissue disorder). Often the injury is not even noticed by patients, and the curve simply develops over time. When this happens, the body doesn’t properly control how much scar tissue develops and too much builds up gradually. A bump of scar tissue forms under the skin of the penis. This bump is called a Peyronie’s plaque.

Treating Peyronie’s Disease

Rarely, men who present with the symptoms of Peyronie’s disease experience improvement without treatment, while other men have lived with the condition for months or longer and require more interventional treatment.

If the curvature of the penis does not correct itself over time, it’s important to discuss treatment options with a urologist. Surgery is considered the gold standard therapy, but other treatment options may help.

Surgery remains the gold standard treatment for Peyronie’s disease. There are several surgical options including:

Excision – this procedure involves removing or cutting of the plaque and attaching a graft. This method will straighten the penis and restore some lost length. Risks of the procedure include numbness of the tip of the penis and decreased rigidity of erections in a small number of patients.

Plication – this procedure involves removing or pinching a piece of the tunica albuginea from the side of the penis opposite the plaque, to straighten out the penis. This method is less likely to cause numbness or erectile dysfunction, but it is associated with a decrease in penile length.

Penile Prosthesis – For patients with Peyronie’s disease and erectile dysfunction, placement of an inflatable penile prosthesis (penile implant) is used to increase the rigidity and straighten the penis adequately. Penile prosthesis remains the gold-standard treatment for patients with ED and Peyronie’s disease.

Medical therapy/injection therapy

Medical therapy, or injection therapy, is often used to decrease pain and inflammation, or soften plaque. The goal of medication injected directly into the area of the plaque formation is to reduce the plaque as well as diminish pain and curvature of the penis.

Xiaflex – The first FDA approved non-surgical treatment for Peyronie’s disease is approved for use in men with a palpable lump from plaque in the penis that causes a curvature of at least 30 degrees during erection. This prescription medicine works by decreasing the plaque that causes the curvature of the penis and involves a series of injections. The injections are given in your doctor’s office and most men receive as many as four treatments, each of which is two injections of the drug. The treatment does have side effects that should be discussed with your urologist.

Bladder neck reconstruction

Complications from surgery or radiation to the prostate can occur after treatment of malignant diseases like prostate cancer, or after procedures for benign prostatic hyperplasia (BPH). If scar tissue develops at the outlet of the bladder, also called the “bladder neck,” it can make urinating difficult and result in problems with urinary retention or even urinary tract infections. This is called a bladder neck contracture, and various surgical options can help alleviate the problems.

Most often, your surgeon can perform a minimally invasive, endoscopic procedure to open this area. But sometimes the scar can return. If this happens, Bladder Neck Reconstruction is a procedure that involves making a connection (anastomosis) of the bladder neck to the membranous urethra after the prostate is removed. Your surgeon will discuss all options, and help you decide on the best choice for you.

Urinary incontinence

Following treatment of prostate cancer – surgery, radiation, or brachytherapy (“seeds”) – patients can experience leakage of urine due to side effects of the therapy.  Some patients will improve with non-invasive treatment such as pelvic floor physical therapy, but others may have leakage that means they must wear pads or other absorbent products. This can significantly impact a patient’s quality of life, leading to avoiding social interactions, decreasing the amount of fluid one drinks, impacting sexual activity, etc. Depending on unique patient characteristics, treatment options could include a minimally invasive sling procedure, or even an Artificial Urinary Sphincter device that can give you back control of your bladder. Your urologist can help you decide on the best option to achieve your individual goals.