Genitourinary Reconstruction

Disorders of the lower urinary tract or the genitals may require surgery to resolve. AHN doctors offer multiple treatment and surgical options to provide relief. 

Buried penis

This occurs when the penis is of normal length but hidden under surrounding tissues, including the abdomen, scrotum, and/or scarred skin. This can make it difficult to urinate.

Some men experience a spraying stream or dribbling or have difficulty emptying their bladder. Urine may be trapped in the surrounding skin and cause inflammation that leads to further scarring, which can worsen over time. It can also be difficult or impossible to have a normal erection and be sexually active. A buried penis can be caused by obesity, lymphedema, or scarred skin, and is diagnosed by physical exam. 

Treatment options

Lifestyle modifications

Diet, exercise, and weight loss can help. While weight loss may not always cure a buried penis, it can make surgery and recovery easier. It will also prevent a recurrence of the condition.

Medications

If skin infections and irritation occur due to constant moisture, your doctor may prescribe medicine to treat these issues.

Surgery

Surgical options include exposing the buried penis by removing scar tissue, a staged flap repair, and in some cases skin grafting. A panniculectomy — removal of excess skin and tissue from the lower abdomen — may also be performed. 

Urethral stricture

This occurs due to scar tissue in the urethra. Narrowing can be mild and cause minimal to no symptoms, or it could be severe and cause significant issues. Severe strictures can result in the inability to urinate and lead to bladder or kidney damage. Symptoms may include:

• Weak or split/spraying urine stream
• Difficulty starting or continuing a urine stream
• Recurrent urinary tract infections
• Pain with urination
• Blood in the urine
• Feelings of incomplete bladder emptying
• Urinary urgency and frequency

Causes of urethral stricture

Trauma

A stricture can develop anywhere along the urethra. Trauma to the penis or pelvis can lead to urethral scar tissue. An example includes straddle injury, which is usually caused by falling onto an object while in a straddled position such as falling onto the crossbar of a bike or a tree limb.

Another type of trauma is a pelvic bone fracture, which might occur from a vehicle accident. This can cause a partial or complete tear along the urethra, sometimes leading to the inability to urinate. Symptoms may be immediate or may occur over time as scar tissue develops.

Instrumentation/Prior urethral and urological surgery

This can include procedures that introduce an instrument into the urethra. Sometimes instrumentation can cause trauma that later leads to scarring.

Infections

Recurrent urinary tract infections and sexually transmitted diseases, especially if left untreated, can result in urethral stricture.

Lichen Sclerosus/Balanitis Xerotica Obliterans (BXO)

This skin condition causes a whitish discoloration on the penile skin and may lead to urethral stricture.

Radiation

Penile and pelvic radiation is a risk factor for urethral stricture formation.

Hypospadias and other congenital disorders

These may occur during the maturation process and lead to urethral stricture.

Unknown

Sometimes the reason remains unknown or perhaps a combination of
multiple risk factors.

Evaluation:

History and physical exam. It’s important to discuss any trauma or surgeries to your genitourinary tract. It’s also helpful to review medical records if you’ve had related prior surgeries and procedures. A physical exam will determine if you have lichen sclerosus or a congenital disorder such as hypospadias.

Labs, tests, and procedures

• Urinalysis to look for signs of infection or blood tests to check your kidney function.
• Post-void residual is a simple ultrasound performed in the office to check
  for bladder emptying.
• Renal ultrasound can ensure your kidneys aren’t affected if it’s determined that you’re not emptying your bladder.
• Uroflow is a simple office procedure that measures the flow rate of
  your urine stream.
• Cystoscopy/ureteroscopy uses a small camera passed through the urethra to evaluate the location and severity of a stricture.
• Retrograde urethrogram is a simple minimally invasive procedure using special contrast dye that shows up in an X-ray. 

Urethral stricture treatments

Observation. In some cases, a urethral stricture can be small and not cause many symptoms. Observation includes an evaluation every few months to ensure the condition isn’t worsening. Simple observation is appropriate when the patient:

• Isn’t bothered by symptoms.
• Is emptying their bladder appropriately.
• Does not have an infection.

Surgery. Surgical options range from minimally invasive endoscopic surgery to
more complex surgery requiring an incision. Common treatments include:

• Suprapubic tube (SPT): In the case of a severe stricture, an SPT can be placed temporarily until the doctor can decide on the best course of action.
• Urethral dilation: The surgeon uses instruments that gradually stretch the stricture and open it up, allowing urine to flow more easily. It is an outpatient procedure.
• Urethrotomy: In this outpatient procedure, a cystoscope is inserted into the
  urethra. Then, using a laser or knife, the stricture is cut open.
• Urethroplasty: This is the most effective form of urethral stricture management. Urethroplasty uses an incision made through the skin to the location of the stricture. There, the urethra is reconstructed or replaced. 

Contact us

Call (412) DOCTORS (412) 362-8677 or, request an appointment to learn more about genitourinary reconstruction.