This content is sponsored by MedStar Washington Hospital Center.
After cancer treatment or traumatic injuries, many patients may think they’re stuck with life-changing symptoms like painful urination, erectile dysfunction, or urinary leaking. However, reconstructive urologists at MedStar Washington Hospital Center work to treat these symptoms using the latest techniques and technologies.
Reconstructive urologic surgery can repair damage, scar tissue, or malfunctions that affect your ability to properly urinate or get or hold an erection. Dr. Nathan Shaw, a reconstructive urologist for MedStar Health, said cancer survivorship and traumatic injuries are common reasons people seek this treatment.
“The most straightforward is radiation damage causing scarring,” Dr. Shaw said. “And that’s particularly true in men with prostate cancer.”
Roughly two percent of prostate cancer survivors develop urethral strictures or scarring of the urethra. Sometimes, this scarring can cause urinary or sexual function issues that impact a patient’s quality of life. Dr. Shaw said some of his most grateful patients are those who suffer from male urinary incontinence following prostate cancer treatment.
“Unlike a lot of women who suffer incontinence, male incontinence is not common,” Dr. Shaw said. “If you go online, there are just fewer things about it, it’s harder to find, there are fewer options for you, and they’re all a little more invasive.”
Technology used by reconstructive urologists at MedStar Health include robotic-assisted surgery. This techniques has become the gold standard for several procedures.
“The minimally invasive techniques offered by the robot are really nice for patients. Not having a big open incision, getting out of the hospital more quickly,” Dr. Shaw said.
He typically performs robotic surgeries for conditions resulting from radiation or similar damage, but the technique is also used to treat and prevent further scarring caused by prostatectomies. He calls the technology hugely beneficial for post-operative discomfort, recovery time, and cosmetics.
Dr. Shaw also treats those who suffer from erectile dysfunction and see little to no benefit with medications like Viagra or Cialis. There are two available options for patients who haven’t had success with oral medications.
One option is the placement of a device inside the penis through penile implant surgery.
“These have been around for 30 plus years— constantly being improved upon to reduce infection risk and make them simpler to use and more durable,” he said.
Inflatable implants, the more common of the two options, can be filled with fluid from an implanted reservoir to create an erection, and deflated when not in use.
Semirigid rods are implanted under the skin of the penis and are always firm. They can be bent toward a partner for intercourse or concealed towards the patient’s body when it’s not in use.
Dr. Shaw said patients are usually very satisfied with the surgery.
“They absolutely have side effects and risks associated with the surgery to put them in,” Dr. Shaw said. “But overall, fantastic, great option for many, many men— particularly those who have had prostate cancer or other issues where those medications by mouth probably are just not going to be effective.”
Risks associated with penile implant surgery include infection, malfunction, or internal erosion, in which the implant wears down the skin on the inside of the penis.
Erectile dysfunction can also be treated with an injectable medication that goes directly into the penis. The most common injectables are Trimix, Bimix, and papaverine. In this case, a nurse practitioner will teach patients how to administer the medication.
This method can bypass obstacles that cause oral medications to fail. However, Dr. Shaw said this process can be uncomfortable and cause a loss of spontaneity with a partner.
“Some guys just don’t have the dexterity in their older age to be able to do that,” he said.
An inevitable subset of patients Dr. Shaw treats are those with traumatic injuries that require urgent reconstruction.
“A great example of that would be a patient who gets into a car accident. And because of the severe injury to the pelvis, the bladder basically ruptures like a balloon would rupture, and it needs to be somewhat urgently sewn back together,” Dr. Shaw said.
Other conditions that can require reconstructive urology include hypospadias, pelvic organ prolapse, and peyronie’s disease. MedStar Health also has experts that specialize in all aspects of gender affirmation.
Be sure to speak with a urologist if you have symptoms related to your urinary tract.
Read more about MedStar Washington Hospital Center’s reconstructive urology on the MedStar Washington Hospital Center’s website.
