Tulane Urology

Urology Reconstruction

Tulane Urology has a long history of being a leader in urologic reconstructive procedures. For comprehensive urological care, including both lower and upper urinary tract reconstruction, Tulane Urology offers the full range of expertise, equipment, and experience. Whether using the latest da Vinci robotic technology or advanced techniques, we are equipped to handle all aspects of urinary tract reconstruction—from the urethral meatus to the distant calyceal diverticulum.​​
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It is crucial for patients to receive care from experienced surgeons utilizing the latest technologies and innovations.​

Conditions Treated

Conditions treated at Tulane Urology include disorders of the upper and lower urinary tracts, Peyronie’s disease, hypospadias, and other conditions affecting the urethra and male external genitalia. We specialize exclusively in the treatment of these conditions. 

Urethral (Lower Tract)

The lower urinary tract extends from the bladder to the tip of the urethra, with more prevalent issues occurring in men. These conditions may include urethral strictures in the penile, bulbar, or bulbo-membranous regions, pelvic fracture urethral injuries, lichen sclerosus, complications from radiation and prostate surgeries, fistulas, bladder neck stenosis, and more.

Types of lower tract conditions include:

    • Urethral Strictures: Urethral strictures occur when the urethra narrows due to scarring or injury, blocking normal urine flow and causing discomfort or urinary problems.
    • Bulbar Strictures: Bulbar strictures occur most commonly in the bulbar urethra, located under the scrotum in the perineum.
    • Pelvic Fracture Urethral Injuries: A pelvic fracture is a serious injury that can tear the urethra beneath the prostate, ranging from a partial to complete rupture. It is most often caused by motor vehicle accidents but can also result from crush injuries, such as work-related falls or other trauma. This type of injury may also be referred to as a prostatomembranous urethral injury or a pelvic fracture urethral distraction defect. Regardless of the name, patients typically think of it as a torn urethra that needs repair.
    • Lichen Sclerosus: Lichen sclerosus, also known as balanitis xerotica obliterans, is an acquired, non-cancerous disease of the penis and urethra. Though it is not contagious or sexually transmitted, its exact cause remains unknown, despite being chronic and often debilitating.

Ureteral (Upper Tract)

Ureteral (upper tract) reconstruction is typically required to address kidney obstructions that extend to the bladder. These conditions can include ureteral narrowing or blockage, ureteropelvic junction obstruction, ureterovesical stenosis, congenital kidney and ureter anomalies, trauma, prior surgical complications, and more.

Types of upper tract conditions include:

    • Ureteropelvic Junction Obstruction: Ureteropelvic junction obstruction (UPJO) is one of the most common causes of kidney drainage blockages. This condition refers to the obstruction of urine flow from the kidney pelvis to the ureter, which drains urine into the bladder. There are various causes for this blockage, including internal scar tissue, crossing renal vasculature, and kidney stones.
    • Ureteroureterostomy: Ureteral strictures can occur for several reasons, leading to blockages in the ureter (the tube that drains urine from the kidney into the bladder). Common causes include multiple episodes of kidney stones, medical procedures involving the urinary tract, radiation therapy for cancer, and trauma such as gunshot wounds and surgical injury.

Genital Reconstruction

These conditions may include penile reconstruction (due to trauma, cancer, or congenital defects), scrotal and testicular reconstruction, Peyronie’s disease, buried penis, impotence (penile implant surgery), and more.

    • Peyronie’s Disease: Peyronie’s disease is a condition where scar tissue or “plaque” forms inside the penis, causing it to bend or curve during erections. This curvature can lead to pain, difficulty with intercourse, and emotional distress. In advanced cases, reconstructive surgery may be necessary to correct the curvature and restore normal function. To learn more, visit the Peyronie’s Disease page.
    • Congenital Anomalies (Hypospadias and Epispadias Repair in Adults): Patients with a history of childhood surgeries for congenital anomalies, such as hypospadias or epispadias, may experience complications like fistulas, strictures, or curvature. When initial repairs fail or complications persist, additional reconstructive surgery is needed to restore function and alleviate symptoms.
    • Cancer-Related Male Genital Reconstruction: Men who undergo surgery for genital cancers, such as penile or urethral cancer, may face tissue loss and functional challenges. Genital reconstruction aims to restore form and function, addressing issues like urethral strictures, tissue loss, and cosmetic concerns.
    • Lymphangioma and Hidradenitis Suppurativa: Lymphangioma and hidradenitis suppurativa are chronic conditions that cause discomfort and disfigurement in the genital area. Surgical reconstruction often involves excising affected tissue and using skin grafts or flaps to restore appearance and function.

Male Urinary Incontinence

These conditions may include stress urinary incontinence due to prior prostate surgeries, pelvic trauma or surgeries, radiation therapy, and damage to the urethral sphincter. To learn more, visit the Male Urinary Incontinence page.

Patient Questions

"If I had urethral dilations and direct vision internal urethrotomies in the past, but my stricture keeps coming back. I’m tired of the cycle of recurrence and procedures. Is there a better, long-term solution?”

Urethral stricture is a recurring condition if the underlying problem isn’t addressed. Procedures like urethral dilation or direct vision internal urethrotomy (cutting the stricture from the inside) are quick outpatient treatments, but they come with high recurrence rates. Each time these are repeated, they increase the risk of the stricture worsening because tearing or cutting the tissue creates more scarring as it heals.

The best long-term solution is urethroplasty, an open surgery designed to permanently resolve the issue. Based on the stricture’s length, severity, and location (evaluated through a retrograde urethrogram X-ray and a brief cystoscopy), we decide on one of two main approaches:

  1. Anastomotic Urethroplasty: Removing the scarred section and reconnecting the healthy ends.
  2. Substitution Urethroplasty: Using a graft, typically from buccal (cheek) tissue, to widen the urethra.

All evaluations and surgeries are performed under my care to create a personalized plan that ensures lasting results and gets you out of this cycle for good.

“My urologist mentioned a new method of urethral dilation called Optilume. Does Tulane Urology offer this treatment?”

Yes, we are one of the first centers in the Southeast to start performing Optilume.

We have all the necessary equipment and have seen excellent results with it for patients whose strictures meet the criteria for this treatment. I’d recommend scheduling an evaluation to determine if Optilume is the right option for you.

“I had a car accident in 2020 and underwent a urethroplasty in 2021 in another state, but my urethra wasn’t fixed. I’ve been using a suprapubic tube ever since, changing it myself. I’ve seen a few urologists, but they told me it’s not fixable. Can you help?”

Post-pelvic fracture urethral stricture is a complex and challenging condition that requires specialized skills and equipment to repair. After completing a fellowship focused on these surgeries and teaching them in regions with higher rates of pelvic fracture urethral disease, I have developed a proven track record of success with these procedures.

It’s important to note that before surgery, no procedures, including urethral dilation, should be performed for at least three months. After the surgery, you’ll need to have a catheter in place for three weeks. Once the healing period is over, we’ll perform another X-ray to confirm that the urethra is open and functioning properly.

If you’d like to explore your options, we can schedule an evaluation to create a plan tailored to your specific condition.

“I had prostate surgery two years ago. I was fine for three months, but then urinary difficulties came back. I’ve had a couple of dilations since. What should I do?”

It sounds like you may have developed a urethral stricture or bladder neck contracture, which can sometimes occur after prostate surgery. While dilations can provide temporary relief, they often don’t offer a long-term solution and may lead to more scarring with repeated procedures.

The best approach is to evaluate the underlying issue with imaging, such as a retrograde urethrogram and cystoscopy, to determine the exact location and severity of the obstruction. Based on the findings, we can recommend a definitive treatment plan, which might include surgical options like urethroplasty or bladder neck reconstruction.

These treatments aim to provide a permanent solution and significantly improve your quality of life. I’d recommend scheduling a consultation so we can assess your condition and develop a personalized treatment plan.

If you’d like to explore your options, we can schedule an evaluation to create a plan tailored to your specific condition.

“Do you perform prostate surgery?”

Yes, we offer all types of prostate surgeries, including minimally invasive, endoscopic, and robotic procedures. The type of surgery you need will depend on your prostate’s size (evaluated through imaging) and the findings from a cystoscopy.

The treatment plan is a mutual decision—we’ll discuss your options, I’ll provide my recommendations, and together we’ll decide on the best approach. This ensures you’re fully informed and comfortable with the treatment plan.

“I have incontinence after my prostate surgery. Can you help me? Does my insurance cover that?”

Yes, we perform a variety of incontinence surgeries to address different causes, including incontinence after prostate surgery and other conditions. One of the most effective options is the artificial urinary sphincter, which involves placing a cuff around the urethra and a pump near the scrotum. The cuff keeps the urethra closed—when you want to urinate, you simply press the pump to release the pressure.

Before surgery, we’ll evaluate your specific condition to determine the best treatment option for you. Most insurances cover these surgeries, but we’ll confirm your coverage details during your first visit to ensure everything is in place before proceeding. Let’s schedule a consultation to discuss your options and create a personalized treatment plan!