Category Archives: Penile

Failed Urethroplasty Treatment In India

Failed Urethroplasty

Failed Urethroplasty treatment by one of the best Reconstructive Urologists. Urethra is one of the most vital parts of the body, thatregulates the excretion of urine from the body. In men, urethra also forms the passage for the ejaculation of sperms. However, this thin, fibro-muscular tube could also be easily ruptured, causing severe pain. In most of the cases, urethroplasty serves as the best course of action if there is any injury or defect inside the urethra.

Failed Urethroplasty

What is failed urethroplasty

Failed Urethroplasty is a surgical procedure to treat any rupture inside the walls of urethra. These ruptures could be caused due to trauma, infections or physical injuries. Urethroplasty is considered to be the go-to medical procedure, since the success rate in urethroplasty is quite high.

During urethroplasty, the urethra is reconstructed via surgical procedure and using a urethral catheter. This catheter is left inside the urethra for few weeks, during which time urethra is completely healed.

 

Types of urethroplasty

Based upon multiple factors (like the physical condition of patient, severity of defect, status of urethra etc.) there are generally 4 types of urethroplasty:

 

1) Anastomotic urethroplasty

This is a single-stage surgery, where the urethra is envisioned (in the range of the deformity), and the cut is made at its mid-line (as a rule), utilizing a bovie blade to dissect both the dermal as well as sub-dermal layers until the related musculature, corpus cavernosum, ventral urethral perspectives and corpus spongiosum are uncovered. Specific care is provided amidst the procedure to avoid any harm to nerves and veins (which could become a cause of erectile dysfunction or loss of penile sensitivity).

This technique is quite successful, with a rate of success over 95%. Anastomotic urethroplasty is viewed as the “best quality level” of surgical repair alternatives, since it is comparatively easier with high success rate.

2) Buccal mucosal onlay graft

In this technique, the range of the defect is assessed and marked horizontally mid-line, and the sutures are situated (one, each) at the proximal and distal closures of the zone of urethra nearest to fringe of the blemished territory. At the same time, a urological specialist who is expert in buccal mucosal gathering systems will start to collect and repair a segment within cheek of the patient, relative to the measurement/shape ascertained and asked for by the specialist performing the urethral part of the methodology.

With a high success rate of 87-98%, buccal mucosal onlay urethroplasty is viewed as the best of repair alternatives for strictures larger than 2 cm long.

3) Scrotal/penile island graft

This type of surgery is carried out in male patients. A scrotal graft (or, in some cases, a penile island flap) is sutured in the location, fixed with firbin glue to prevent any leakages. The whole process is carried out using micro surgical techniques. Due to high complexity, this type of urethroplasty has a success rate of 70-85%, thus making is not an attractive choice. However, in cases of strictures larger than 4cm, it could be opted for.

4) Johansen’s urethroplasty

This complex urethroplasty involves opening the urethra ventrally, while a skin strip (usually created from scrotum) is buried inside for the repair. Due to its high complexity, only a few cases have ever opted for this, thereby making no data for success rate available.
Failed urethroplasty

Even though urethroplasty is the benchmark for any treatment of urethra, it is not completely successful. Severe complications might occur in up to 12% of the cases, while minor ones might be as high as 40%. Let’ take a look at some of the causes of failed urethroplasty:

 

  • The major cause for failure in case of anastomotic urethroplasty was the inadequate excision of the wound at the top of prostatic urethra. Surgery in case of scars around the urethra often leads to failures. Other causesincludeischemia and tension hematoma. In general, defects that have existed for a longer time have higher chances of having a failed urethroplasty.
  • In case of buccal mucosal onlay graft, the success rate is generally better. The main causes include formation of proximal anastomotic ring or distal anastomotic ring, or the loss of entire graft. In presence of these factors, BMG urethroplasty is generally discouraged. However, in other cases, it gives excellent results.
  • The length of strictures directly affects the success of any urethroplasty. In almost every case, stricture with greater length at a higher risk factor associated with them.
  • As opposed to popular notion, the size of defect has almost no impact upon the success of the surgery. Likewise, the patients’history of previous urethroplasty has no importantinfluence on the outcome of the current operation.

Statistically, the chances of the urethroplasty getting failed are quite low. In case of BMG urethroplasty, for example, there is less than 3% chance that any significant complication would arise. However, no matter how small, the chances of a failed urethroplasty always persists. The complications that arise are generally minor ones. Some of such post-surgical complications are:

 

  • The stricture may not be completely eliminated, and might return after surgery.
  • The patient might suffer from urinary incontinence, which is the involuntary leakage of urine. This complication is more common in women.
  • The patient could suffer from erectile dysfunction. In most cases, this is a temporary post-surgery symptom, but sometime it could become a severe condition in itself.
  • Urinary retention is also a common complication, where the patient might not be able to completely empty the bladder even after many attempts. Due to this, the patient might get the urge to urinate frequently.
  • Retrograde ejaculation is a less common, but more severe complication. In this case, the patient is unable to ejaculate the semen via urethra, which instead gets deposited in the urinary bladder. This is not a symptom and must be treated immediately.
  • Bleeding from both external and internal sature lines.

 

Conclusion

Urethroplasty is one of the most popular courses of actions in case of ruptured or infected urethra. Countless patients, with their success stories, have popularized this surgery among people and doctors alike. However, failed urethroplasty is not unheard of, and the factors that contribute to them must be kept in mind. Patients must be aware of the complications that might arise in case of urethroplasty procedure those are not successful, and what must be done in that case.

To know more please contact :

Dr. Gautam Banga

MBBS,MS,M.Ch (Urology)
Urologist, Andrologist and Genito -Urinary Reconstructive Surgeon
Contact no. : 91- 9886624303 | +91-9999062316
Email:- info@urethraandpenilesurgery.com

Testicular Pain Treatment- by Dr. Gautam Banga

Testicular Pain: Causes, Prevention and Treatment

Testicular Pain treatment explained by Dr. Gautam Banga

As Men, we might consider ourselves lucky as far as gender-specific conditions are considered. We do not have to face the discomfort of monthly periods, nor the agony of labor pain preceded and followed by different complications. Life is good, you might say. But testicular pain is one condition which only Men suffer from, and it could be pretty horrifying.

Almost every Man under the age of 25 has faced some kind of testicular pain once in his life. However, despite the alarming rate, not many people are aware about the causes and treatment of testicular pain. While most cases of testicular pain are mild and are cured over time, some severe cases may be symptoms of cancer and hernia.

testicular pain treatment

What is testicular pain and how is the testicular pain treatment done?

Testicular pain could be defined as the pain originating in the scrotum and testicles of Men. Although the causes and severity varies, the pain in the general area is broadly classified as testicular pain. Testicular pain could be caused by a variety of reasons, but the symptoms remain fairly common. Even the mild pain in the scrotum due to an accidental hit is categorized under testicular pain.

Causes of testicular pain

Testicular pain is more of a symptom than a condition itself. The causes, in effect, are varied and difficult to diagnose easily. Some common causes are:

  • Formation of kidney stones can affect the scrotum, leading to pain in the area.
  • The testicles or scrotum could be infected, as in a case of acute epididymitis.
  • Sexually transmitted diseases also affect the testicles, causing pain in the region.
  • In cases of enlarged prostate, testicular pain is one of the most common symptoms.
  • Infections causes by some bacteria could cause inflammation in the testicular region, as in the case of acute orchitis.
  • The most severe cause is the cancer of testis, which has a regular symptom of testicular pain.
  • Other conditions like tumors and gangrene can also cause testicular pain.

Identifying testicular pain

The most common reason behind this condition not being talked about is the sheer ignorance. People are not sure if the pain in their testicles is due to the scratch/hit that had some time ago, or due to something more serious.

In general, if you face more than one of the following symptoms, then maybe you are suffering from testicular pain:

  • Tenderness in the testicles
  • Swelling of testicles
  • Redness in the scrotum
  • Pain during urination
  • Fever or vomiting

Understanding the level of pain

Testicular pain has a very wide-ranging severity level.It could range from mild discomfort to agonizing pain. Following are the types of pain you could feel in your testicles/scrotum:

  • Torsion occurs in the testes when the spermatic cord is obstructed, affecting of flow of blood. It is one of the severest testicular pains, and demand immediate medical attention.
  • Inflammation of testes due to bacterial infection results in orchitis. It is a severe pain that needs medical treatment.
  • Inflammation of epididymis (a tube situated on the back of testicles) could be a case of epididymitis. It is also a severe testicular pain that needs to be treated immediately.
  • In case of prostatitis, which is the swelling of prostate gland, the pain is constant and moderate. However, it could cause severe inflammation at times. Medical attention is required.
  • In case of kidney stones, the pain is moderate and recurring. Most people tend to ignore the symptom in this case. However, it requires the removal of kidney stone.
  • Testicular trauma is caused due to physical harm to the testicles during sporting activities or accidents. The pain is moderate, but would subside over time. Pain relievers are enough to deal with it.

Complications in testicular pain

Pain in the testicular region could be caused due to a variety of reasons. Thus, the complications arising from late or lack of treatment are also varied. However, some common complications are:

  • Loss of testicles
  • Infertility or impaired fertility
  • formation of pus in the scrotum
  • Decrease in the size of testicle
  • Infection in the blood
  • Infection in the kidney

Prevention of Testicular pain treatment

Like the famous saying goes, prevention is better than cure. However, since there are many causes of testicular pain, the preventive measures are many and need to be exercised cautiously. In case of pain caused by infection, the most common cause is STDs. Protective measure like condom could prevent them to a large extent.  Some other infections could be prevented by immunization and antibiotics (under the prescription of a doctor).

The most common cause of mild testicular pain is testicular trauma. This could be prevented by wearing protective devices during activities that risk damage to the testicles.

Testicular pain treatment

The treatment for pain in testicles/scrotum depends upon the cause of the pain. Some treatments that must be taken, in accordance to the cause, are:

Torsion

Being the severest kind of testicular pain, it requires immediate surgery. You could contact a urologist for the same. The main objective of the surgery is to untwist the spermatic cord that has caused the torsion. Sometimes, the untwisting could be done manually, without surgery. However, these cases are rare, and surgery is the safest option.

Viral or Bacterial infection

In cases of orchitis or epididymitis, the first course of medication usually involves pain killers. Furthermore, antibiotics are administered in order to kill the infection. In some rare cases, the testicles might be needed to be removed. However, in most cases, the most you would need is scrotum support or some other form of elevation, so that the pain is reduced without the need of pain relievers.

Hernia

Hernia is a severe condition which must be treated immediately. In most cases, surgery is the preferred solution. However, in the most extreme cases, it is not surgically feasible to repair the damage, and the entire organ needs to be removed.

Testicular Cancer

If the testicular pain is caused due to tumor, you need to contact an oncologist and admitted into the hospital for long-term medication. Surgery might be the safest option to remove the tumor. In some cases, chemotherapy is suggested to kill the tumor. Testicular cancer could be fatal, so the treatment must not be balked under any circumstance.

Testicular trauma

The trauma is caused due to physical strain over the testicles/scrotum, caused mostly during sporting activities. It might result in rupture of the testicles. In most cases, it is fine to contact a physician who might suggest pain killers and scrotum support. However, in case of rupture, immediate medical treatment is required so that the testicles are not damaged further.

Chronic Testicular Pain Treatment

If you are suffering from a chronic pain in the testes that has no apparent reason, conservative treatments might not have desired results. In such cases, microsurgical denervation of the spermatic cord serves as a best chance. Also known as cord stripping, the process is simple, almost pain free and has great results. The main benefit of microsurgical denervation of the Spermatic Cord is that it is minimally invasive, thus eliminating any chances of unwanted complication.

This testicular pain treatment comes into play in cases where spermatic cord blocking has shown to reduce pain. More than 70% of the times, the treatment was successful in eliminating the pain completely, while rest of the times it resulted in reduced pain to a great extent. Microsurgical Denervation of the Spermatic Cord also preserves the organs (testes and scrotum), thus eliminating the risk of infertility.

Conclusion

Testicular pain might be a common issue among Men, but that does not mean that it should be taken lightly. It can very well be a symptom of something serious, and negligence might only complicate the matter further. If you think that you are suffering from testicular pain, it is always wise to contact a urologist for further diagnosis and get the testicular pain treatment . If the condition is serious, you must not hesitate from undergoing a surgery. Delay in testicular pain treatment could lead to infertility and removal of testicles. Testicles are vital parts of your body and not easily replaceable, so it is better to keep them safe.

To know more please contact :

Dr. Gautam Banga

MBBS,MS,M.Ch (Urology)
Urologist, Andrologist and Genito -Urinary Reconstructive Surgeon
Contact no. : 91- 9886624303 | +91-9999062316
Email:- info@urethraandpenilesurgery.com