Reconstructive surgery is commonly known for cosmetic procedures. World over, there has been a steady awareness and demand for breast enlargement, nose job, facelift, etc. While the utility of such treatment is debatable, there is another offshoot, called reconstructive urology, which is progressively seen steady growth.
Several congenital ailments leave lifelong handicaps. One such is hypospadias, where the location of the male urethral opening is abnormal. This leaves a boy failing to void himself normally. This occurs in 1 in 300 live births and due to lack of specialized centers, undergo repeated surgeries Two eminent surgeons, Culp and McRoberts had poignantly emphasized: “It is the inalienable right of every boy to be a pointer instead of a sitter by the time he starts school and to write his name legibly in the snow.” With modern techniques, most of these boys undergo a single-stage repair, reducing morbidity and mental trauma.
Ureteropelvic junction (UPJ) obstruction is by far the most common cause of pediatric kidney disease, occurring in 1 per 1000-2000 newborns. Minimally invasive reconstruction with Laparoscopic and Robotic techniques have made it feasible to treat this challenging condition with three 2 mm ports, and the child is discharged within 24 hours.
Prostate related diseases affect 10- 24% of an aging male. Many end up requiring surgery and this may sometime lead to post prostate surgery urinary incontinence. Traditionally, pads, penile clamps, and catheters were the only solutions. However, modern reconstructive procedures like Advanced Male Sling and Artificial Urinary Sphincter enable one to regain urinary control.
Urethral Stricture (narrowing of the urethra affecting urinary flow), is a relatively common disease in men with an associated prevalence of about 0.6%. Trauma remains the most common etiology in developing and Third World countries, with about 90% of men presenting with complications, including the lifetime dependency on a catheter. Modern repair techniques (aka Urethroplasty), use tissue transfer from the mouth, tongue and penile skin, etc., to reconstruct the scarred urethra, with high success rate of above 90%.
Urinary incontinence is increasingly afflicting more and more people. Most adopt coping methods like adult diapers, fluid restrictions, etc., which yield less than ideal outcomes. Stress incontinence (loss of urinary control on coughing, straining) is common in some women after multiple childbirths, leaving them prone to recurrent urinary tract infections and social embarrassment. TVT (tension-free vaginal tape) was introduced in Sweden in 1995. It quickly becomes the “gold standard” operation for treating women with stress urinary incontinence, with almost 85% cure rate.
Overactive bladder (OAB) is another common bothersome ailment afflicting about 15 -17% of healthy individuals. Standard treatment with lifestyle alterations and medications can relieve milder forms of OAB. However, side effects of drugs and inadequate relief used to leave these patients frustrated. Interstim- bladder pacemaker is an effective treatment for this condition, which allows an individual to lead a normal life.
Aging populations and trauma have increased the incidence of erectile dysfunction. When medical management fails, penile prosthesis is the way forward. These artificial implants provide adequate concealment and functional outcomes, enabling normal conjugal lives and fertility.
Management of Genitourinary cancers has made significant progress and most are cured. However, living without a urinary bladder for a bladder cancer patient is a daunting task. At FMRI, Neo-bladders are being routinely made using modern laparoscopic and robotic techniques, enabling one to live without urine collection devices. Emasculation as a sequela of penile cancer treatment and penile trauma is psychologically and physically devastating. Penile reconstruction using forearm muscles enables great aesthetic and functional outcomes and FMRI is one of the few centers in India offering these services.
