April 4, 2017
In males, the urethra is an approximately 20 cm long tube that runs through the penis and connects to the bladder, providing an exit for urine as well as semen.
Urethral reconstructive surgery often corrects stricture, a narrowing of the urethra caused by injury or infection that are severe or non-responsive to other procedures.
The condition occurs in up to one per cent of all males and across all age groups but becomes more common as one ages.
“In some cases, we can repair the urethra by removing the stricture and reconnecting the healthy ends together,” says Dr. Keith Rourke, urologist and director of the urethral reconstruction program at the Alberta Health Services facility. “More commonly the stricture is either too long to simply remove and we have to rebuild the urethra using the inner lining of the mouth or an alternative skin graft from the patient.”
Patients with a urethral stricture may suffer from pain, urinary infections and even kidney failure. Typical patient symptoms leading to the surgery include lower urinary tract issues, such as weak urinary stream, straining to urinate, urinary hesitancy, incomplete emptying and excessive urination during the night. Approximately one in three cases progress to a complete inability to urinate, or completely empty the bladder.
“Unfortunately, there continues to be a stigma around talking about men’s health,” says Dr. Rourke. “Sadly, a lot of men suffer in silence when there are treatment options available.”
Harvey Marchand, 73, developed scar tissue in the urethra in 2009 that impacted his ability to urinate and caused urinary incontinence (difficulty controlling the urine). Two previous attempts to remove the scar tissue provided only temporary relief.
Five years later, Dr. Rourke assessed Harvey and recommended a two-step approach to surgery. First, urethral reconstruction was performed to repair the stricture that was resistant to other treatments. Then he implanted a mechanical valve to restore urinary control.
“For a time, I had completely lost control of my bladder and had to rely on personal protection pads to get through the day,” says Marchand. “Since receiving the implant, I have control over my bladder again. I’m back at work; I can wear light pants without the fear of staining them. I’m starting to ride my bike again. I have come full circle. I can’t thank Dr. Rourke enough for what he’s done for me.”
The UAH is a urology referral centre for Western Canada, performing more than 1,500 major genital and urinary organ reconstructive surgeries since 2003, including more than 1,200 urethroplasties/urethral reconstructions, more than 100 major genital reconstructions, and
232 surgeries for male incontinence after prostate cancer treatment.
“We have some of the best published outcomes internationally for our patients,” says Dr. Rourke. “Surgery may sound scary to a lot of men but, thanks to surgical interventions, most patients will see quality of life improve exponentially.”
The Edmonton program is currently the second busiest program in North America, second only to a program in Dallas, Tex.
Few urologists perform these types of procedures as training was previously hard obtain. But that’s changing: in 2013, the University of Alberta’s Faculty of Medicine and Dentistry created a fully accredited and internationally recognized fellowship in reconstructive urology. This fellowship is fully accredited by the Society of Genitourinary Reconstructive Surgeons and trains Canadian, American and foreign urologists in the sub-specialty.
“The creation of the clinical urethral reconstruction program has allowed for the provision of exceptional care for patients who, in the past, have found it difficult to find experts in the field,” explains Dr. David Williams, Chair of the Department of Surgery, University of Alberta.
“The academic program within the Faculty of Medicine & Dentistry at the University of Alberta will allow the program to flourish through education and research, ensuring that patients in the future will receive the best care possible.”
Alberta Health Services is the provincial health authority responsible for planning and delivering health supports and services for more than four million adults and children living in Alberta. Its mission is to provide a patient-focused, quality health system that is accessible and sustainable for all Albertans.
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