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Male Reconstructive Urology

Many people live with symptoms of urinary disorder for years before seeking treatment, causing unnecessary grief and possible long-term problems. The urologists at UC San Diego Health are leaders in treating complex disorders of the male urethra and genitourinary system.

In addition to delivering state-of-the-art care, our team is heavily involved in research, and has developed novel treatments for some of the most complex urologic conditions. For our research efforts and clinical care services we are consistently ranked among the top urology programs in the nation by U.S. News & World Report

The surgical treatment of complicated urinary obstructions requires extensive expertise in performing delicate surgeries. Our specialists offer precise treatments for male genital and urethral disorders that can help you avoid repeated procedures and return to enjoying a healthy life more quickly.

When to Consider Surgical Treatment

When there is a problem, like a stricture, the bladder has to squeeze harder to eliminate urine. You may experience severe pain, excessive straining or prolonged time to empty while urinating. Eventually, the bladder may begin to show signs of damage, including thickening or enlargement of the bladder itself. In some cases, the backup of urine can cause irreversible damage to the bladder and kidneys. 

Conditions We Treat

Urethral Stricture

A urethral stricture, also known as a urethral obstruction, is scar tissue that builds within the urethra, making it difficult to urinate. Because of its length and location, the male urethra and genitourinary system are especially prone to injury. 

Urethral strictures are more common in men because their urethras are longer than those in women. 

In some cases, the cause of urethral stricture is not known. 

Factors that may result in urethral stricture:

  • Previous hypospadias surgery
  • A traumatic incident, like a car accident or bicycle injury
  • Urethral cancer
  • Sexually transmitted diseases like gonorrhea and chlamydia
  • Procedures that involve placing a tube into the urethra

Symptoms of urethral stricture include:

  • Bloody or dark urine
  • Loss of bladder control
  • Swelling of penis
  • Pain in the pelvic area or lower abdomen
  • Blood in semen
  • Discharge from the urethra
  • Frequent urination
  • Slow urine stream that develops gradually
  • Spraying of urine

Urethral stricture can be treated with urethroplasty, a minimally invasive surgical procedure that removes or widens the narrowed section of the urethra. The recurrence of strictures after urethroplasty is very low. 

Other treatment options for urethral stricture include dilation, catheterization, endoscopic urethrotomy, endoscopic urethrotomy, or a permanent catheter or artificial stent.

Urethral Stricture Complications, Recurrence and Failed Repairs
Our team specializes in treating people who have ongoing urethral stricture complications, as well as those who are experiencing urethral stricture recurrence from failed repairs or surgeries. 

Hyposadias

Hypospadias is a rare birth defect where the opening of the urethra in males is on the underside of the penis instead of at the tip.

Treatment of hypospadias in infants typically involves surgery to reposition the urethral opening. Sometimes when the patient becomes an adult, this treatment leads to complications, including urethral strictures or fistulas. We provide revisional surgery for adults seeking treatment of these complications.

Trauma

The genitourinary system is involved in roughly 10 percent of trauma cases.

When pelvic bones near the prostate and urethra are fractured, the forces can also tear the urethra, rupture testicles or cause trauma to the scrotum. Activities that can lead to genitourinary trauma include:

  • Sports or recreational activities
  • Automobile and motorcycle accidents
  • Work-related activities

Common symptoms of a genitourinary tract injury include:

  • Difficulty urinating
  • Bruising or pain on the groin or scrotum
  • Fractures in the pelvic bone or lower rib
  • Bloody urine

Benign Prostate Hyperplasia

Over 50 percent of all men over the age of 60 experience benign prostate hyperplasia (BPH), a condition that leads to annoying changes in urinary flow. 

Incisionless Surgery to Treat Enlarged Prostate

A ​minimally invasive implant can dramatically reduce BPH symptoms while also preserving sexual function. Read the article.

At UC San Diego Health, the first line of treatment for BPH is a safe, minimally invasive implant that can help significantly reduce lower urinary tract sy​mptoms while preserving sexual function. The eight-minute procedure is done under light sedation with a device called Urolift. As there are virtually no side effects, this procedure is a good alternative to traditional surgeries that require removal of prostate tissue, which can cause complications such as erectile and ejaculatory dysfunction. 

BPH may also be treated with a type of prostate surgery called transurethral resection of the prostate (TURP). This surgery treats an enlarged prostate by removing the inner part of the prostate gland. The surgery takes about one hour and can be done under general or spinal anesthesia.

Complications Following Prostate Cancer Treatment

Prostate cancer is more common in men. In fact, more than 180,000 men in the U.S. will be diagnosed with prostate cancer this year. There are many effective prostate cancer treatment options available today (i.e. surgery or radiation). However, these treatments can sometimes cause complications to the genitourinary area, including:

  • Rectourethral and urethral fistulas, which are abnormal holes between two organs that normally don’t connect. Fistulas are a rare but devastating complication of pelvic surgery, radiation and genitourinary cancers. A rectourethral fistula, also known as a urinary rectal fistula, is a small hole that forms between the urethra and the rectum. A urethral fistula is an abnormal opening within the urinary tract. Our team treats these conditions by closing the hole that has formed within or has connected to the urethra. 
  • An obstructed or blocked urethra, which can make it difficult to urinate. Two things that can cause a blocked urethra:
    1. Urethral stricture
    2. Bladder neck contracture: A radical prostatectomy removes the prostate and then connects the bladder neck directly to the urethra. If this connection narrows due to scarring, this is called a bladder neck contracture. Robotic prostatectomy, offered at leading cancer hospitals like Moores Cancer Center at UC San Diego Health significantly reduces the incidence of bladder neck contractures.
  • Urinary incontinence is bladder leakage due to a weakened urethral sphincter, the muscles that help you control when you urinate.

About the Male Urethra

The male urethra is a long, delicate tube that begins at the bladder neck, runs through the middle of the prostate and throughout the length of the penis. Because of its length and location, the male urethra and genitourinary system is especially prone to injury. Obstruction or scarring of the urethra can lead to lifelong difficulties with urination. 


Appointments and Referrals

Location

La Jolla

Meet Our Specialist

Dr. Jill Buckley, a leading expert in male reconstructive urology, has co-authored numerous research studies and several surgical textbooks on urethral reconstruction, acute urinary trauma management and genitourinary reconstruction. She is nationally recognized for her work in complex urinary reconstruction.

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