Reconstructive Urology at Chesapeake Urology Associates
For patients affected by disorders of the genitourinary system including urinary tract injury or post-surgical injury and stricture disease, Chesapeake Urology's Reconstructive Urology program is helping patients who require total or partial reconstruction of the urinary tract.
The program is led by Andrew Chang, M.D., a fellowship-trained physician and one of the region's foremost specialists in this emerging sub-specialty of urology.
What is Reconstructive Urology?
Reconstructive urology is a sub-specialty of urology that focuses on restoring normal urine flow in both the upper and the lower urinary tract following injury or obstruction of the urethra. The urethra is the tube that extends from the bladder out of the body to expel urine. When injury occurs, slow urine flow, urinary tract infection, urinary incontinence and bladder infection can become real problems for patients.
Patients are often referred to a reconstructive urologist when they have urethral stricture disease (scar tissue in the urethra that can cause a blockage or obstruct urine flow) due to radiation or chemotherapy from prostate cancer treatment, congenital abnormalities of the urinary tract, neurogenic bladder, ureteropelvic junction (UPJ) obstruction, as well as an urethral injury (bicycle straddle injury is a common cause of urinary problems in men, for example). A reconstructive urologist has the experience and specialized training necessary to perform intricate surgical procedures that restore a patient's urinary function and quality of life.
Chesapeake Urology's reconstructive urologist, Dr. Andrew Chang, specializes in the following surgical services:
- Urethroplasty for the treatment of urethral stricture disease
- Male incontinence surgery
- Bladder reconstruction
What is Urethroplasty?
For patients with urethral stricture disease, urethroplasty is often the treatment of choice. Urethral stricture is the build-up of scar tissue in the urethra, which blocks the flow of urine. Urethral stricture is often caused by inflammation or injury in or around the urethra.
Several types of urethroplasty procedures exist. Two examples include:
- Buccal graft urethroplasty is a procedure where the reconstructive urologist will take tissue from the skin lining inside of the mouth and transfer or graft the tissue to the urethra to create an open pathway for urine.
- EPA- excison and primary anastomosis - Cut the bad segment of urethra out and put back together without any additional grafts or flaps.
SURGICAL PROCEDURES FOR URETERAL INJURY AND CONGENITAL CONDITIONS
In addition to urethroplasty for stricture disease, Dr. Andrew Chang, Chesapeake Urology's reconstructive urologist, performs reconstructive surgery for patients who experience ureteral injuries as well as congenital conditions including:
- Boari flap and Psoas hitch - For ureteral injuries that are close to the bladder, the reconstructive urologist creates a flap out of the bladder (boari flap) to substitute the segment missing in the ureter, or can perform a psoas hitch, which attaches a portion of the bladder wall to the psoas muscle.
- Ileal ureteral substitution and transureteroureterostomy (TUU) are urinary diversion techniques that take a segment of the small bowel to replace portions of the ureter damaged by injury. These procedures are typically performed on large defects of the ureter.
- Laparoscopic pyeloplasty is a surgical procedure performed to correct an obstruction between the kidney and the ureter (the tube that carries urine to the bladder).
Male Incontinence Surgery
Urinary incontinence is the involuntary leakage of urine and is caused by a problem with a man's urinary tract. Urinary incontinence in men is typically related to problems with the prostate and often occurs following prostate surgery as well as after treatment for prostate cancer.
Incontinence is not just a physical issue but also a social and emotional problem for many patients. When urinary incontinence is a result of a urethral injury from surgery, radiation and other therapies for prostate cancer, Chesapeake Urology's reconstructive urologist provides men with several treatment options:
- Male slings - a mesh sling is placed beneath the bladder neck/urethra area and is attached to surrounding muscle tissue or pubic bone to provide support and minimize urine leakage.
- Urethral bulking - A bulking agent is injected around the urethra to provide extra support and to control urination and leakage.
- Artificial Urinary Sphincter (AUS) - This is a silicone-rubber medical device that fits around the urethra and can be inflated or deflated to control urination.
For patients who have injury, severe damage to the bladder often caused by bladder cancer and subsequent therapies, as well as congenital abnormalities and conditions such as neurogenic bladder, Chesapeake Urology's reconstructive urologist specializes in bladder reconstructive surgery including:
- Urinary diversion and neobladder - for patients with bladder cancer or who have had their bladder surgically removed, a reconstructive urologist surgically constructs a new bladder out of surrounding bowel tissue to avoid use of a colostomy bag to pass urine out of the body.
- Augmentation cystoplasty - For patients with a small bladder capacity, this procedure enlarges the bladder by grafting the organ to a detached segment of the small bowel or intestine.
- Continent catheterization stoma - a surgical opening (stoma) through which a catheter is placed to drain urine from the bladder.
Other Conditions Treated by a Reconstructive Urologist
In addition to urethral stricture disease, male incontinence and bladder reconstruction, reconstructive urologists have an in-depth understanding of the male genitourinary system and conditions that affect this system. Dr. Andrew Chang has extensive training in the treatment of other male conditions including:
- Peyronie's Disease - Peyronie's disease is a condition of the connective tissue of the penis that causes the abnormal growth of plaques, or scar tissue, in the tissues that encase the two long cylinders that run the length of the penis. This can cause pain, abnormal curvature, loss of girth and/or shortening of the penis, as well as erectile dysfunction or indentation
- Surgical treatments:
- Penile 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.
- Plaque excision - The removal or cutting of the plaque and attaching a graft. This method will straighten the penis and restore some lost length.
- Erectile Dysfunction (ED) - ED is a persistent inability to maintain an erection that is firm enough or lasts long enough to complete sexual intercourse. ED is often a sign of an underlying health issue such as diabetes, high cholesterol, obesity, sleep apnea, low testosterone or cardiovascular disease.
Reconstructive urologists are skilled at surgical interventions for ED such as penile prosthesis or implants. Surgical placement of an inflatable penile prosthesis (penile implant) in the penis is a viable option for men when other interventions fail, including oral medications.
- Surgical repair of vesicovaginal and ureterovaginal fistulas and recto-urethral fistulas - Fistulas are an abnormal connection or passageway between two organs or vessels that normally do not connect. Dr. Chang is experienced in performing surgical procedures to repair fistulas that often result as complications after major pelvic surgery or after radiation therapy or a radical prostatectomy.