The Urology Reconstructive handles the surgical repair of congenital or acquired disorders that affect the function or cosmetic appearance of the organs of the genitourinary system in men and women. Many times these anomalies are treated in a sub-optimal or incomplete way due to the limited experience in most Chilean hospitals and clinics in the field of genitourinary reconstruction.
The lack of experience in this matter often results in the application of inappropriate treatments that do not cure the patient’s problem in a definitive way and force him to go through the operating room again and again.
However, there are advanced surgical techniques that allow the patient to return to the lost function and quality of life. Dr. Rajinder Yadav has more than 40 years of experience in urological reconstruction, which allows us to receive patients, regardless of their diagnosis or previous treatment, to start the path to a definitive solution.
- Congenital Penile CurvatureThe penis is not necessarily a symmetrical organ and when erect it can exhibit varying degrees of curvature.
These curvatures are quite frequent and cause many visits to the urologist. While by themselves they do not imply a serious condition, they can generate significant difficulties in the patient’s sexual life, causing great anxiety and self-esteem problems.
In the vast majority of cases, these are slight curvatures that do not alter function and in which no treatment is necessary. However, when the curvature of the penis is more pronounced, it can become more than just a cosmetic problem and cause discomfort in sexual intercourse and even make penetration impossible. In these cases, the only possible treatment is a surgical intervention in order to straighten the penis.
There are several techniques to achieve the desired results and the choice will be made according to the characteristics that arise in each case. This surgery is very well tolerated and delivers highly satisfactory results.
- Peyronie’s diseaseThe Peyronie ‘s disease is an acquired pathology, causes not well established but can be linked to traumatic events. It is characterized by the appearance of a fibrous induration in the tunica albuginea that surrounds the corpora cavernosa of the penis. This fibrosis is like a scar that is felt as a hardness that can appear on the shaft of the penis, causing a painful discomfort in the erection. In more advanced stages it can produce curvatures that can be very accentuated and disabling.
The treatment of Peyronie ‘s disease is surgical and consists of replacing the damaged tissue, using various grafts to correct the deformity. There are various techniques and each has its pros and cons, so each procedure is discussed in detail with the patient. Despite being a delicate surgery, it allows to obtain excellent results and recover sexual capacity in the vast majority of cases.
- Penile IncreaseAlthough there is no technique that allows the size of the erect penis to be enlarged, it is possible to apply techniques that increase the cosmetic appearance of the flaccid penis.
It is important to emphasize that the real size of the penis is what it reaches in an erect state and that it cannot be increased by surgical intervention.
This surgery is strictly cosmetic and recommended when the penis retracts excessively in its flaccid state, causing a reduced appearance. It is important to discuss the details and goals in detail with the patient, as well as to establish a realistic level of expectations. When properly indicated, this surgery provides an acceptable solution to a fairly common problem.
- Penile ProsthesisIn well-selected cases and when other treatment alternatives have failed, the penile prosthesis implant is an excellent solution that allows to recover sexual life with a high degree of satisfaction for the patient and their partner.
The implant surgery penile prosthesis is indicated in the treatment of dysfunctions of erection when alternatives are ineffective or not applicable.
This surgery consists of the implantation inside the penis of a biocompatible silicone rubber device that is capable of giving the penis the necessary rigidity for normal sexual penetration. These devices are implanted internally and do not affect the normal appearance of the penis.
- Burns and Skin LossThe loss of skin coverage of the genital organs (penis and scrotum) is one of the most dramatic injuries in urological practice, which endangers the function and cosmetic appearance of the genitals and causes a profound psychological impact on the patient.
This type of injury is more common in patients who have suffered significant burns or accidents, which also affect other parts of the body.
Treatment should be aimed both at preserving genital functions (erection, urination, production of sperm and hormones) and at restoring a normal cosmetic appearance of the genitals. The skin loss can be total or partial, and can involve the penis, scrotum, or both. For reconstruction, free flaps or grafts can be used, or a combination of flaps and grafts, depending on the etiology and extent of the injury. The sexual, reproductive and general status of the patient is also of great importance when deciding the type of reconstruction to use.
- Trauma / Penile FractureTraumatic rupture of the corpus cavernosum occurs primarily during intercourse, but can also occur during masturbation and other circumstances in which excessive stress is placed on the erect penis. This injury is commonly unilateral, but can compromise the urethra in up to 20% of cases.
When the erect penis is forcibly twisted the rupture is characterized by pain and a cracking sensation. The injury produces a hematoma and deviation of the shaft of the penis to the opposite side of the rupture. If there is damage to the urethra, there will be pain, difficulty urinating, and blood from the meatus.
The treatment is surgical and must be carried out as soon as possible to repair the rupture, which allows to fully recover the function of the penis when it is carried out in time.
- Female Urinary Incontinence
- Male Urinary Incontinence
- Vesical enlargement / EnterocystoplastyBladder enlargement or enterocystoplasty is used to enlarge the bladder when it is not large enough, whether it is the result of a neurogenic bladder, interstitial cystitis, trauma, sequelae of a previous intervention, etc.
This surgery allows creating a low pressure urinary container, for which the patient’s bladder is enlarged using a piece of intestine. This allows the need for permanent catheterization to be replaced by a much more satisfactory intermittent self-catheterization.
In many cases, this intervention can be a fundamental step for the complete rehabilitation of a patient who has suffered a serious accident, with neurological compromise at the level of the spine.
- Bladder fistulasFistulas are an abnormal communication between two cavities. In the case of the bladder, fistulas affect neighboring organs, such as the intestine, ureter, vagina or rectum. This abnormality can be caused by an infection, tumor, radiation therapy, or previous surgery.
These fistulas are necessarily a complex problem, so each case will require an individualized diagnosis to determine the type of intervention required.
- Urinary ReservoirsThe neobladder is a solution that replaces the external urinary collectors in patients who have suffered injuries that prevent the normal functioning of the bladder (neurogenic bladder) or who have had their bladder removed as a treatment for cancer.
For this, the surgery must create a container or internal urinary reservoir of low pressure and high capacity, which can be emptied voluntarily when the patient deems it necessary. There are many techniques, but all of them use different portions of the intestine.
In some cases this container or internal urinary bag is connected to the ureters and the urethra allowing the flow of urine from the kidneys to end in a voluntary urination, similar to normal, replacing the need for an indwelling catheter and / or an external reservoir. . In other cases in which the urethra cannot be used, this container is connected to the outside through a conduit whose entrance is placed at the bottom of the navel so that it is practically not noticeable, and the same patient draws urine several times. a day by passing a probe through this tube.
Although it is a complex surgery and it may have limitations, it is the best alternative to replace a lost bladder. The degree of acceptance and success is considerable and allows the patient to resume his life more normally.
- Bladder TraumaLike kidney trauma, bladder injuries can be penetrating or closed, the latter being the most serious. Since the bladder is very well protected by the solid pelvic cage, its rupture is usually associated with serious accidents.
These are generally polytraumatized patients, whose complexity does not lie in the bladder injury itself but in the numerous associated injuries, which can be more compromising. Timely intervention makes it possible to avoid complications and contribute to the success of the patient’s recovery.
Approximately 70% to 80% of blunt bladder trauma is associated with a pelvic fracture, and 5 to 10% of pelvic fractures are associated with bladder injury.
Surgical techniques to solve the problem are varied and, in some cases, require a complete diversion of the urinary flow, so they constitute complex interventions that must be performed in specialized centers.
The intervention must also be performed in a timely manner and in conjunction with the other surgeries required to stabilize the traumatized patient.
- Neurogenic BladderThe neurogenic bladder is a condition typical of patients who have suffered spinal cord injuries as a result of an accident that fractures their spine. These spinal cord injuries usually cause serious sequelae such as paraplegia or tetraplegia and also seriously alter the normal ability of the bladder to store urine.
In the past, these cases did not receive further treatment and patients had to use permanent urinary catheters or external urine collectors, which frequently leaked and caused great discomfort. Currently, patients are taught to probe their urine 4-5 times a day. This system is called intermittent catheterization or bladder self-probing and is the best alternative available today. However, it requires that the bladder has good storage capacity and that there is no urinary incontinence. When the bladder is very small and / or when there is incontinence, a bladder reconstruction is required.
Each case is different and there are numerous therapeutic actions to achieve good management, which can only be obtained in a specialized rehabilitation center. Our Center has the largest and oldest experience in rehabilitation of spinal cord injuries (paraplegic and tetraplegic) in the country. Since 1984 our Service has controlled more than 500 patients with this condition, achieving degrees of rehabilitation not achievable in other centers.
Neurogenic bladder reconstruction has proven to be a contribution to the physical, social and emotional rehabilitation of spinal cord injured patients, thus representing an essential component of comprehensive rehabilitation.
- StenosisThe ureters are the tubes that carry urine from the kidney to the bladder.
Stenosis, or narrowing, in the ureter is a rare condition, which usually occurs as a result of trauma, inflammation or the aftermath of a surgical intervention.
Stenosis of the ureter produces an obstruction that prevents the flow of urine from the kidney to the bladder, leading to progressive kidney damage. This can occur on one side or both sides, the latter being very serious because it causes kidney failure.
In general, the recommended treatment is surgical. Due to the rarity with which these cases occur, there are few specialists who have considerable experience in handling these situations.
- Ureter traumaTraumatic injuries to the ureter are rare, mainly due to the flexibility and retroperitoneal location of this organ. The most frequent injuries are caused by a surgical intervention in the area, while those due to external violence are usually caused by penetrating trauma (knife or firearm). Blunt abdominal trauma injuries are rare and occur mainly at the junction of the ureter with the kidney.
In the case of high velocity projectile wounds, damage can occur without the bullet touching the ureteral wall, because the large energy released spreads radially at a distance. In these cases, it is necessary to recognize that there may be serious damage to a macroscopically normal ureter upon surgical inspection.
Injuries to the bladder and ureter represent a great challenge in their management, especially if they are not well diagnosed in time and their initial treatment is inadequate. In this context, the failure of the primary repair of a bladder rupture or the presence of a ureteral fistula can represent complications that are frequently associated with septicemia and can even threaten the life of the patient.
- Kidney malformationsHorseshoe kidney
Horseshoe kidney occurs in about one in 500 children. It occurs during fetal development when the kidneys move toward their normal position in the flank area (area near the side, above the waist). However, in the case of the horseshoe kidney, as the fetus’s kidneys develop from the pelvic area, they fuse at the lower poles of both kidneys. In doing so, they adopt a “U” configuration, giving it the name “horseshoe.”
In the vast majority of cases this condition does not cause any problems. However, occasionally these kidneys are complicated by obstruction at the level of the ureter or by the development of stones. When this happens, the surgery is much more complex due to the shape and position of these kidneys.
An ectopia implies a malformation in the location of the organ, with respect to its normal location. In the case of the kidney, ectopia occurs when one or both kidneys are in a different place than they should occupy in the abdominal cavity.
A crossed ectopia is one in which the kidney is located on the opposite side to the one it should occupy and its ureter empties correctly into the bladder. A renal ectopy, however, can be accompanied by an ectopic ureter, which joins the kidney with the urethra or seminal glands, in men, or with the uterus or vagina, in women.
This malformation consists of a narrowing of the Urethral Skin junction, which can cause difficulty in emptying the kidney. This condition usually produces constant and even pain in the lumbar region, which is not related to a pathology of the spine.
When it is not treated, it can generate hydronephrosis, increasing the size of the kidney due to swelling and fluid accumulation. Its surgical treatment is indicated in cases in which the functioning of the organ is compromised and when the patient reports permanent pain.
- Kidney traumaIn general, kidney trauma does not present as isolated events but is usually seen in patients with multiple injuries. Renal trauma occurs in 8 to 10% of abdominal trauma and is divided into penetrating and closed, with 80 to 90% of them being closed.
80% of penetrating trauma and between 20 and 33% of blunt trauma to the kidney have associated intra-abdominal injuries. The most frequent cause is vehicular accidents, although they can occur in any traumatic event that involves the abdominal cavity.
Depending on the severity of the damage, surgical intervention can help to rebuild the organ, returning to the patient, to a greater or lesser extent, the lost kidney function. It is important to understand that all trauma is different and that the results will depend on the depth of damage to the kidney.