Urinary Tract Reconstruction - Miami, Fort Lauderdale, West Palm Beach
Dr. Angelo Gousse founded Gousse Urology over 25 years ago. Over that time, he has established numerous urology clinics throughout the South Florida region. Local residents can depend on Dr. Gousse to treat their neurogenic bladder conditions or urethral trauma.
Dr. Gousse is one of the foremost experts in urinary tract reconstruction. Not only is he a renowned urologist in South Florida, but his scientific research contributions to the urology field are recognized throughout the country. Other urologists have learned from Dr. Gousse’s work and implemented his treatment techniques into their urology practices. It is safe to say that his contributions have changed the urology practice for the better.
If you have a urinary tract condition or suspect that you have one, you must come to Gousse Urology for a checkup as soon as possible. Make an appointment by calling (305) 606-7028 or contacting us here.
An Overview of Urinary Tract Reconstruction
The urinary tract is what transfers urine from the bladder to the penis or vagina. It also transfers semen to the penis in men. When the urinary tract suffers damage, it can get repaired with a urinary tract reconstruction procedure. Failure to repair the damage could lead to painful urination, urination difficulties, and sexual dysfunction.
There are multiple parts of the urinary tract, such as the sphincters, urethra, and bladder. If any one of these parts gets damaged, it must be repaired to restore the full functionality of the urinary system.
During your physical examination, Dr. Gousse will determine which areas of the urinary tract have been compromised. Based on the examination results, he will develop a treatment plan to fix the problem and reverse its effects.
Here are some of the ways in which the urinary tract can get damaged or dysfunctional:
- Contracting a sexually transmitted disease
- Previous surgery of the urethra
- Perineal trauma
- Urethral strictures
- Cancer radiation treatment for the pelvis
Have you experienced any of these situations? If so, you should make an appointment to visit Dr. Gousse and his team at Gousse Urology. Please call (305) 606-7028, and contacting us here to get started.
Dr. Gousse: Urinary Tract Reconstruction Specialist
Dr. Gousse graduated from Yale School of Medicine. He’s made over 70 contributions to scientific journal publications from around the world. You can trust Dr. Gousse to administer world-class urologic treatment for your urinary tract problem. His three specialties include ureteral removal and reimplantation, bladder augmentation and urethral reconstruction.
Sometimes these three procedures are performed consecutively, depending on the severity of the urinary tract damage. Anyone with ureteral cancer, trauma or disease will need their ureteral to be removed and repaired via surgery. After that, it will get reimplanted back into its original position.
Bladder augmentation surgery may be needed to enlarge the bladder size following the ureteral reimplantation. It is also necessary for people who have a neurogenic bladder from multiple sclerosis or a spinal cord injury. If the urethra needs widening, a procedure known as urethroplasty (or urethral reconstruction) will be performed.
Make an Appointment at Any of Our South Florida Clinics
Dr. Gousse created the Bladder Health & Reconstructive Urology Institute to treat specific urologic conditions via urinary tract reconstruction. Gousse Urology has set up numerous South Florida clinics in Miramar, West Palm Beach, and Aventura.
Dr. Angelo Gousse is fellowship trained training in upper and lower urinary tract reconstruction.
Procedures can include:
The procedure is typically indicated after ureteral trauma or injury of the ureter by cancer or other disease processes. The ureter can be refashioned, reconstructed, and then re-implanted into the urinary bladder On occasion, the urinary bladder has to be reconstructed or moved prior to the reimplantation / reconstruction (Psoas Hitch Procedure or Boari Flap). A typical hospital stay is 3-4 days with a Foley catheter in the bladder for 1 or 2 weeks.
Bladder augmentation using intestinal segments such as colon or small intestines to enlarge the urinary bladder. This procedure is usually performed in patients with neurogenic bladder after spinal cord injury, spina bifida or multiple sclerosis. Urodynamic (bladder testing) may indicate a very high bladder pressure that is dangerous to the kidneys or leakage per urethra (incontinence). The findings are caused by high bladder pressures or involuntary (spastic) contractions. Making the bladder larger by patching a segment (10-20 cm) of intestine into the bladder will decrease the bladder pressure and help protect the kidneys and achieve urinary continence.
On occasion, it is not possible to catheterize per urethra and a catheterizable tube (channel) has to be constructed using intestinal segments or the appendix (Mitrofanoff). An anti-incontinence valve is created using intestines and special surgical techniques to allow the catheter to go in the augmented bladder very readily without allowing urine to leak out. Dr Gousse has performed more than 250 bladder augmentation procedures. The average hospital stay is 7 days after this procedure.
Benign diseases of the urethra which affect urine flow and/or blaldder emptying very often require surgical intervention. Urethral strictures and urethral narrowing (stenoses) are treated by various techniques. The treatment for urethral strictures include numerous options, such as dilation with sounds or plastic dilators, urethrotomy (cutting scar tissue with a knife by going through the penis), stent and open reconstructive surgical techniques. The treatment choice will be dictated by the specific urethral condition or the surgeon’s preference. Although less effective long-term, urethral dilation and direct visual urethrotomy (DVIU) continue to be the most commonly used techniques.
They have a high failure rate with recurrence in at least 50% of patients. Most patients who undergo these procedures require repeated interventions for recurrences. Often the patients progress to surgical repair. Persistent use of dilation or urethrotomy for the treatment of urethral strictures may be the result of the urologist unfamiliarity with the published literature and inexperience with urethroplasty surgical techniques. Open urethral reconstruction (Urethroplasty) is the international gold standard treatment for urethral strictures. Urethroplasty is not a routine operation and a lack of the necessary skills should prompt a referral to a specialist skilled in urethroplasty.
There are two types of Urethroplasty. Many surgical techniques with or without grafts have been developed to allow the aesthetic reconstruction of the glans and the penis while repairing the strictured areas.
Basically, the surgical technique for urethral reconstruction is selected according to the cause and location of the urethral stricture disease. The choice between an anastomotic versus a tissue transfer technique is aided by a radiograph (retrograde urethrogram), surgeon experience and preference. The choice must, in addition be based on the proper anatomic characteristics of the penile tissues to ensure flap or graft take and survival. Urethroplasty is a open surgical procedure for urethral reconstruction to treat urethral stricture. Urethroplasty can be performed by 2 basic methods; Excision and anasmotomis (primary repair) which involves complete excision of the narrowed part of the urethra and the subsequent rejoining of the proximal and distal patent luminal segments. The second method of Urethroplasty utilizes tissue transfer (flaps) or graft technique. In this method, tissue is grafted from penile foreskin, or buccal (inner lining of the mouth) mucosa and is used to enlarge the caliber of the strictured (narrowed) segment of the urethra. Dr Gousse prefers buccal mucosa graft as his tissue transfer(graft technique) because the graft material is abundant, well tolerated, cosmetic, and successful in most cases. Urethroplasty is typically performed under general or spinal anesthesia. Selected patients may be discharged home on the day of the surgery. Many others will be in the hospital for a day or two. The patients typically wears an indwelling urethral Foley catheter for 2- 3 weeks to allow the repair to heal. After catheter removal, the patients are followed with clinical symptoms, urine flow rate, and post void residual volumes to ensure bladder emptying. Many patients will be able to enjoy baseline sexual function and father children after surgery.
Like all surgical procedures, the results of urethroplasty are not 100%. A recurrence urethral stricture rate of 10 % can be expected long-term. Patients with pelvic fracture associated urethral stricture and prostate involvement associated strictures have the highest recurrence rate. Erectile dysfunction is also most commonly seen in this sub-category of patients.