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.