How Two Urologists at Rutgers Are Improving Quality of Life for Their Male Patients

Surgeons with ties to Rutgers Health and RWJBarnabas provide tips on maintaining urological wellness

Two Rutgers Health alumnae have focused their medical careers on men's urological health, aiming to improve the lives of patients with urinary incontinence and those with erectile dysfunction.

Chrystal Chang is an assistant professor of genitourinary reconstructive surgery at Robert Wood Johnson Medical School (RWJMS) and a surgeon in the Division of Urology at Rutgers Health. Chang practices at Robert Wood Johnson University Hospital(RWJUH), an RWJBarnabas Health facility, in New Brunswick, N.J. and Robert Wood Johnson University Hospital Somerset.

A Rutgers alum, Chang spent her educational career at the university as an undergrad, medical student and Urological surgery resident. She also is one of 20 surgeons in the United States who is a certified center of excellence for an intricate artificial urinary sphincter implant procedure to address leakage in men due to stress incontinence. She performs complex reconstruction for urethral and ureteral strictures, robotic surgery, and has advanced training in prosthetics. She has particular focus in cancer survivorship and trauma patients.

Also practicing at RWJUH, Danielle Velez-Leitner is an assistant professor and the director of men's health in the Division of Urology at RWJMS, and a surgeon at Rutgers Health and the RWJBarnabas Medical Group.

Velez-Leitner said she "grew up" at RWJUH, hanging out in the nurses' stations or lounges while waiting for her mother, a faculty member in the Department of Rheumatology, to finish her rounds. Velez-Leitner, who received her medical degree at RWJMS, performs penile prosthetic surgeries and Peyronie's surgeries, which help men who haven't found a solution to erectile dysfunction or penile curvature.

Chang and Velez-Leitner discuss their specialties that address men's health concerns and offer tips on how to maintain urological wellness.

What is the urinary sphincter implant procedure?

Chang: This procedure is for men who are finding that they leak urine when sneezing, coughing, laughing or lifting. It takes about an hour and a half under general anesthesia, and all patients will go home the same day.

The implant consists of a cuff that supports the urethra, a pressure regulating balloon, and a pump that patients will press every few hours when they feel their bladders are getting full. It takes about five to six weeks to heal and afterwards patients could see 85 to 95% improvement in their symptoms.

What medical conditions or cases would make a patient eligible for a urinary sphincter implant? Are most urologists familiar with it?

Chang: In general, the procedure is for men who have stress urinary incontinence that they have acquired due to bladder outlet procedures, prostate cancer treatments, radiation or bladder cancer treatments. Patients who have been doing pelvic floor physical therapy to improve leakage symptoms, and who have not seen improvement in six months, may be surgical candidates.

Your urologist may certainly recommend insertion of an artificial urinary sphincter for significant stress urinary incontinence. Other surgical options for stress urinary incontinence include male urethral slings and implantable balloon devices. Other nonsurgical options are clamps or condom catheters, however, these also are a big hindrance to quality of life.

What is the inflatable penile prosthesis implant procedure?

Velez-Leitner: The penile prosthetic implant is designed to provide reliably firm erections without changing what patients feel during sexual activity. The surgery takes about one to two hours and patients are usually released the same day.

While there is a malleable prosthetic option, which is always hard but bendable, patients often find that the inflatable provides a more "natural" erection. When they are ready to have sexual activity, they squeeze a pump that is surgically inserted in the scrotum, in between the testicles. The pump cycles fluid from a pelvic balloon into cylinders that are implanted into the penis. That fluid provides the rigidity for sexual activity. When patients are done, there's a small release button on that same scrotal pump that deflates the device. It is a very discrete device, with all components under the skin. Nobody, but you, knows that it is there.

What medical conditions or cases would make a patient eligible for the inflatable penile prosthesis implant? Are most urologists familiar with it?

Velez-Leitner: Any patient who has struggled with erectile dysfunction and finds the medical alternatives to be unsatisfactory is eligible for a penile prosthesis. Penile implants should be considered last-line options, but I find that when patients and couples make that decision to move on to the implant, they're usually relieved to finally have a treatment that they can have confidence in.

Most urologists have had experience with penile implants through their training, but there are certainly urologists who have more expertise with implants than others. There are studies that show that higher-volume centers tend to have better outcomes - fewer complications, less infections.

What tips can you offer to help men maintain their urological health?

Chang: Maintaining a well-balanced diet, exercising, consuming alcohol in moderation, quitting smoking, and staying hydrated are important.

Velez-Leitner: Men should schedule appointments with their primary care providers for routine prostate cancer screenings by blood test and call their doctors if they see any pink or red color in their urine. A lot of urology-specific issues can feel really personal - it's okay to ask your medical provider questions, and if they don't know, ask for a specialist.