There is a grow­ing num­ber of men in T&T who can­not ejac­u­late or uri­nate on their own be­cause of a con­di­tion known as Ure­thral Stric­ture Dis­ease.

Men don’t like to ad­mit hav­ing such prob­lems and ac­cord­ing to the head of the South West Re­gion­al Health Au­thor­i­ty's (SWRHA) Urol­o­gy De­part­ment Dr Kr­ish­na Ram­soob­hag, it of­ten leads to psy­cho­log­i­cal prob­lems.

In al­most all cas­es, men and boys with this dis­ease go about their dai­ly lives with a tube, a supra-pu­bic catheter, in­sert­ed in­to their penis­es in or­der to uri­nate. In se­vere cas­es, the urine is drained through the pa­tients' ab­domen.

On­ly a few urol­o­gists in T&T are able to do a ure­thro­plas­ty, the pro­ce­dure to re­pair dam­aged ure­thras and treat­ment abroad can cost up to US$80,000. How­ev­er, thanks to the part­ner­ship be­tween the SWRHA and the Uni­ver­si­ty of Penn­syl­va­nia, the pro­ce­dure is now more eas­i­ly avail­able lo­cal­ly.

This week, a sur­gi­cal team from the SWRHA's Urol­o­gy De­part­ment did three days of train­ing done with Dr Robert Kovell, an adult re-con­struc­tive urol­o­gist and Dr Christo­pher Long, a pae­di­atric urol­o­gist, both from the Chil­dren's Hos­pi­tal of Philadel­phia in the Unit­ed States.

Kovell ex­plained that the dis­ease oc­curs when there is a nar­row­ing of the ure­thra, the tube that con­nects the uri­nary blad­der to the open­ing of the pe­nis. It can be caused by strad­dle in­juries—trau­ma to the groin area—which can be caused by falls, ve­hic­u­lar ac­ci­dents and sports. It can al­so hap­pen over time from in­fec­tions and a va­ri­ety of med­ical con­di­tions.

“It is com­mon both here and in the Unit­ed States. The biggest ef­fects that it has is that it ba­si­cal­ly blocks a man’s abil­i­ty to uri­nate so guys get symp­toms such as a slow stream, feel­ing like they have to push to uri­nate, even go­ing in­to uri­nary re­ten­tion where they re­quire a supra-pu­bic catheter.

"If they don’t have that and try to con­tin­ue to void through it, long-term there is a chance that it can cause long-term dam­age ei­ther to the blad­der or to the back part of the ure­thra from them try­ing to push and push. The ure­thra would con­stant­ly be ex­pand­ed and dam­aged. The worst case sce­nario is es­sen­tial­ly them re­quir­ing a long-term in-dwelling tube,” Kovell said.

Ram­soob­hag said pub­lic hos­pi­tals ad­mit at least 30 new pa­tients with the dis­ease an­nu­al­ly. It most­ly af­fects males be­tween the ages of 16-40 and in many cas­es is caused by a blow to the groin while play­ing foot­ball. With­out a ure­thro­plas­ty, pa­tients suf­fer re­peat in­fec­tion and a life of uri­nat­ing through a tube.

With the hands-on train­ing, the lo­cal sur­gi­cal team will be able to car­ry out rou­tine pro­ce­dures. More com­plex cas­es will be left un­til Kovell and Long's re­turn in 2019.

Ram­soob­hag said with on­go­ing train­ing sur­geons will be able to per­form the com­plex pro­ce­dures on their own. How­ev­er, Kovell said they have al­ready been ex­celling at the com­plex pro­ce­dures. In fact, SWRHA urol­o­gist Dr Trudy Kaw­al had al­ready been ex­posed to the train­ing dur­ing a fel­low­ship at the uni­ver­si­ty last year.

Chil­dren born with de­fects

Ure­thral stric­ture al­so af­fects boys born with a de­fect known as Hy­pospa­dias, a con­di­tion in which in­stead of the ure­thra com­ing right out at the very tip, it ends on the un­der­side of the pe­nile shaft. While it may be com­mon, there are var­i­ous sever­i­ties. Treat­ment is not re­quired if there is on­ly par­tial block­age but there is the pos­si­bil­i­ty of in­fec­tion or fer­til­i­ty is­sues.

If the ure­thra stops fur­ther down in the shaft or per­ineum, it be­comes more com­pli­cat­ed, es­pe­cial­ly if the pa­tient has un­der­gone one or two or three op­er­a­tions to try to fix it be­fore. Kovell said in the US, with in­creased use of in vit­ro fer­til­iza­tion, there has been an in­crease in chil­dren be­ing born with the con­di­tion.

How it is done

In the ure­thra, there is a bit of elas­tic­i­ty, so if the stric­ture is be­tween 1-2 cm long and near the prostate, sur­geons can re­move the bad tis­sue and su­ture the ure­thra back to­geth­er. If the stric­ture is longer and the ure­thra has mul­ti­ple le­sions clos­er to the pe­nis where the blood sup­ply is less, sur­geons re­move the scarred tis­sue and re­place it with good tis­sue ex­tract­ed from in­side of the mouth).

“What we tell guys is that re­al­ly good mouth hy­giene is im­por­tant to this. Guys who are chron­ic smok­ers or chew­ers, it is hard­er to use that tis­sue be­cause it gets dam­aged. So with those guys, we can ac­tu­al­ly use a lit­tle bit of the skin from the out­side of their pe­nis in­stead of the mouth tis­sue. But the mouth tis­sue is prob­a­bly the best one,” Kovell said.

He said the suc­cess rate of ure­thro­plas­ty is be­tween 90 to 95 per cent for short­er stric­tures, while there was an 80 to 90 per cent suc­cess rate for pa­tients with a size­able amount of scarred tis­sue. Fol­low­ing surgery, a pa­tient can be dis­charged af­ter 24 hours and re­cov­ery times is up to three weeks.

Kei­th Coop­er, 54, who un­der­went the pro­ce­dure, said it was painful but was re­lieved he would no longer have to en­dure the pain of the block­age. He be­lieves his stric­ture was caused while play­ing foot­ball.

“It was just a lit­tle cut, no big set of cut­ting. I came out of surgery last night and I am go­ing home this af­ter­noon and I feel well,” he said.