Reconstructive Urology: Rebuilding After Injury or Disease
SLUCare surgeon Dr. Clay McDonough says the field of reconstructive urology is about “rebuilding the system” when something goes wrong with a patient’s urinary tract. There may be damage from injury or disease, so it’s his mission to restore structure and functionality to the ureters, urethra and bladder. That can be done in innovative ways, including grafting tissue from other parts of the body.
“About one-third of the people who come to our office are cancer patients, another third have trauma, and others are experiencing fallout from diabetes, vascular disease, neurological problems or other conditions,” McDonough says. “We can perform specialized surgeries and treatments to help them heal and return to normal.” He sees patients at SSM Health Saint Louis University and St. Mary’s hospitals, and is one of a few surgeons in the region providing urologic reconstruction. When a new patient comes in, the team performs imaging and other tests to see how well the person’s urinary system is functioning. Then, they create a plan to manage or repair any problems and return the patient to a more normal state.
Dr. McDonough said my quality of life would increase dramatically after surgery, and he was absolutely right.”SLUCare Patient Bob Gilbert
The SLUCare team is highly skilled at handling complex urological surgeries, according to McDonough. “A recent patient, Bob Gilbert of O’Fallon, Missouri, was born with a malformed bladder and had surgery years ago to divert the urine into his colon,” he says. “Unfortunately, it caused ammonia to get into his blood, which resulted in encephalopathy (abnormal brain function) and increased risk for cancer.” The SLUCare surgical team corrected the problem by using a segment of Gilbert’s small intestine to create a tube that empties from his remaining kidney to a stoma in his abdomen. “Bob was pretty frail when he came to us, but he’s doing much better now,” McDonough explains. “His kidney is draining much more efficiently.”
Gilbert, 68, says the SLUCare team has made a world of difference in his health and happiness. In the past, he had an episode where he became comatose and nearly died because of the ammonia problem. He also had to take a number of medications that made him feel ill. “I was referred to Dr. McDonough, who spent a lot of time with me, carefully explaining why I needed the surgery,” Gilbert says. “I asked if he would give the same advice to a member of his own family, and he said yes. That made me feel good. He has been as much of a friend as a doctor, and the rest of the staff has been wonderful, too. Dr. McDonough said my quality of life would increase dramatically after surgery, and he was absolutely right.”
In other cases, reconstructive tissue can be harvested from the patient’s bladder, rectum or even inside the mouth, McDonough says. “Cheek tissue often works best, depending on how much is needed,” he explains. “The oral mucosa have a good, smooth lining, the vasculature (blood vessel system) is a close match, and the tissue is very similar.”
He gives another example of a young man with failing kidneys who had been told elsewhere that he needed major surgery on his ureters. “We did a urodynamic study and realized the problem was where his bladder and urethra met, so that procedure wouldn’t have worked,” McDonough explains. “We did a more minor surgery and fixed the problem. In the end, patients just want to get back to their lives as quickly as possible. We are here to help with that.”
By: Julia M. Johnson