Male Reconstructive Surgery

Improving Quality of Life for Men

Male reconstructive surgery is a complex subspecialty of urology that can help improve quality of life for men facing various urologic issues and help avoid repeated, temporary repairs.

“Many men are living with a problem where there could be improvement with a reconstructive intervention,” said Dr. Ramiro J. Madden-Fuentes of Concord Hospital Center for Urologic Care.

Dr. Madden-Fuentes listed several key instances in which men could benefit from reconstructive procedures overtreatment that must be repeated, including urethral stricture disease, incontinence after prostate cancer treatment and erectile dysfunction.

He is one of few urologists in New Hampshire performing a reconstruction procedure that in recent years was recommended as the primary definitive treatment for urethral stricture disease. Urethral stricture disease is narrowing of the tube in which urine flows from the bladder. The chronic narrowing can lead to recurrent severe urinary infections, bladder damage, and kidney damage.

For many years, the initial treatment has been to stretch the scarring inside the urethra to open the channel, but for most patients, the repair is temporary, resulting in multiple treatments, which can worsen the scarring and require patients to undergo more complex reconstructive procedures or use catheters chronically.

In a urethral reconstruction procedure (urethroplasty), Dr. Madden-Fuentes removes the diseased area and uses healthy tissue to reconnect the undamaged urethra. This can be done with tissue in the urinary tract or a graft from elsewhere in the patient’s body.

“The benefit of the urethroplasty procedure is that in the long term, you are ideally avoiding repeated procedures that are costly, inconvenient and uncomfortable,” he said.

In men who have undergone treatment for pelvic cancers, such as prostate cancer, urinary control may be difficult. A reconstructive urologist can improve this with a procedure using either a synthetic mesh sling or an artificial urinary sphincter. A sling works by repositioning the urethra. An artificial sphincter acts as the body’s own natural sphincter to control urination.

Many men with erectile dysfunction cycle through various medications, but if medication and other interventions fail, Dr. Madden-Fuentes said a penile implant or prosthesis are good, long-term options.

“These devices last a very long time and there are very high rates of satisfaction,” he said. “You can take a problem that essentially has been chronic in those patients for five, ten, fifteen years, and corrects the problem with one procedure.”

Male urologic reconstructive surgery is a diverse field allowing management of patients with traumatic urinary injuries, dysfunctional bladder, and obstructed urinary flow. Expertise in managing these conditions is critical in preventing complications.

“These are procedures that can lead not to just quality of life improvement, but also decrease the likelihood of subsequent long-term, irreversible effects of a condition,” Dr. Madden-Fuentes said.

* Versus all providers with a urology specialty in Press Ganey’s national Database ( October 1, 2017–September 30, 2018).
Press Ganey Associates partners with more than 10,000 health care organizations, including 50 percent of all U.S. hospitals, to measure and improve their quality of care.

Expert Urology Care Close to Home

In addition to its office on Concord Hospital’s campus, the Center’s board-certified urologists practice in New London, Plymouth, and Wolfeboro, making it convenient for you to be seen close to home no matter where you live in Central New Hampshire.