Reconstructive Urology

Reconstructive urology is surgery to restore normal urinary or sexual function by repairing, rerouting, or recreating areas of the upper and lower urinary tract and some reproductive organs. Dysfunction or damage in the urinary tract can be caused by many things, including trauma/injury, congenital disorders (birth defects), kidney stones, and radiation or surgery for cancer. Patients may experience urine leakage (incontinence), urine blockage, or abnormal connections between organs that greatly reduce quality of life. A few common conditions, treatments, and services provided by reconstructive urologists are listed below:

  • Artificial urinary sphincter: An artificial urinary sphincter (AUS) is an implantable pump used to treat urinary incontinence in both men and women. In men, the device is inserted around the urethra through a small incision under the scrotum. It can significantly reduce uncontrolled urinary leakage in men, an issue that is often seen after prostate cancer treatment. In some cases, the device is implanted to control urinary leakage in women or in patients with neurological conditions such as spina bifida.

  • Men’s Health Clinic: The Men’s Health Clinic at The Kirklin Clinic of UAB Hospital treats some of the most common male health conditions, including infertility, incontinence, sexual health issues, and genitourinary (GU) cancer. Patients receive the most accurate diagnoses and the latest and most effective treatment options available, including complex genital and urinary reconstruction surgery and treatment of enlarged prostate using minimally invasive laser surgery, which means that no cutting is required.

  • Pelvic organ prolapse: Pelvic organ prolapse (POP) occurs when the tissue and muscles of the pelvic floor no longer support the pelvic organs, resulting in the pelvic organs dropping (prolapsing) from their normal position and pushing against or into the vagina. The pelvic organs include the cervix, uterus, bladder, urethra, small intestine, and rectum. The bladder is the organ most commonly involved in POP. The condition is much more common in women but can occur in men, too. The most common risk factors include childbirth, advanced age, a past hysterectomy, obesity, and chronic cough. Symptoms may include pelvic pressure, heaviness, low backache, inability to maintain a tampon, pain during intercourse, difficult bowel movements, and urinary and/or bowel incontinence. Some people with POP have no symptoms. The most serious symptoms in women usually occur when the prolapse reaches the entrance to the vagina and is felt and/or visible by the patient herself. Treatments include observation, a pessary (a prosthetic device inserted into the vagina to support its internal structure), and surgery.

  • Penile implant: A penile implant, or penile prosthesis, is a surgically implanted device used to treat erectile dysfunction (ED). When medications, vacuum pumps, or injection medications do not provide a satisfactory erection, surgical treatments such as this often can correct ED. Erectile dysfunction that requires surgery is sometimes seen in men with diabetes, vascular disease, and in men who suffered trauma or had surgery or radiation treatment for prostate cancer or other cancers. Penile implant surgery often is covered by insurance.

  • Peyronie’s disease: Peyronie's disease is caused by scar tissue inside the penis, resulting in a bent rather than straight penis when erect. Most men with this condition can still have sex, but it can be painful and cause erectile dysfunction (ED) or shortening of the penis in some cases. Peyronie's disease rarely gets better on its own. For men with a slight curve that isn't getting worse and who have good erectile function, treatment usually is not required. However, if the curve is severe or interferes with sexual activity, treatment may help. Treatment options include surgical procedures and Xiaflex (collagenase clostridium histolyticum) injections.

  • Spina bifida: Spina bifida is a condition that affects the spine and usually is noticed at birth. It can cause damage to the spinal cord and nerves and may result in intellectual and physical issues that range from mild to severe, including urinary problems. Treatments include surgery, walking and mobility aids, and medications and other therapies for urinary and/or bowel incontinence.

  • Ureteral stricture: A ureteral stricture is a blockage in the urethra, the tube that carries urine from the kidney to the bladder. It can cause abdominal pain, kidney infections, and permanent kidney damage. Common causes include kidney stones, trauma, blockages present at birth (congenital), problems from previous surgeries, and radiation treatment for cancer. Treatments may include inserting plastic tubes called stents into the blocked ureter tube, or inserting tubes directly into the kidney through the back. Surgical treatment options also are available, often using minimally invasive techniques that require only small incisions (cuts), including use of the da Vinci robotic surgery system.

  • Urethral stricture: A urethral stricture is a blockage in the tube that carries urine from the bladder out of the body. It may cause urinary tract infections, pain or straining when urinating, and difficulty urinating. Common causes include trauma, infection, problems from previous surgeries, and inflammation. Urethral strictures often require a surgical procedure known as urethroplasty to permanently fix the blockage.

  • Urethroplasty: Urethroplasty is a surgical procedure to repair damage to the urethra, the tube that carries urine from the kidney to the bladder. This surgery may be needed because of a blockage that makes it hard to urinate. In men, a small incision is made under the scrotum or on the penis. In women, a small incision is made in the vagina and around the opening of her urethra. The blocked area is then cut out and removed, and the urethra is sewn back together.

  • Urinary incontinence (male): The loss of bladder control is a common condition that can develop at any age, but it tends to occur more often later in life. Although it can be embarrassing, it is highly treatable and is not a normal part of the aging process.

  • Urinary incontinence (female): The loss of bladder control is a common condition that can develop at any age, but it tends to occur more often later in life. Although it can be embarrassing, it is highly treatable and is not a normal part of the aging process.

Why UAB

The UAB Department of Urology features an experienced team of surgeons, physicians, and nurse practitioners who specialize in reconstructing the urinary tract and are dedicated to providing state-of-the-art care. We have the only fellowship-trained reconstructive urologists in the state, and we perform more urethral reconstruction procedures than any other medical center in Alabama, Mississippi, the Florida Panhandle, and western Georgia. We perform more traumatic urology repairs than any other hospital in Alabama. Rest assured that the experts at UAB Urology will be able to offer treatment options for your condition.

 

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