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Research & Education

Gift Giving – Making a Donation – A Note from Dr. Gelman

When I first joined the Faculty of the Department of Urology at UC, Irvine in Orange, CA, a major objective was to establish the first major Center of Excellence in men’s health to treat urethral and penile disorders such as urethral strictures and penile curvature and erectile dysfunction.

However, it was also was my dream to help establish an endowed chair in Urologic Research at UC, Irvine. Although our Center was always engaged in clinical research the basic science laboratory research was not ongoing. Our research led to the development of advances in tissue engineering where the objective was to create a material in the laboratory that could be used to reconstruct the urethra. The research was presented at a Scientific meeting where the presentation won an award. However, the funding was limited, and the project did not continue. Medical research is of little value if it does not translate to improved medical care.

What best insures that medical research will continue indefinitely is endowments. It was always my hope that some day, we would be able to establish an endowment that would insure the indefinite continuation of a Tissue Bioengineering Laboratory at the University of California, Irvine that would be transformative to patient care and improve the quality of the lives of people in the future. After many years of hoping, this dream came true. With a generous donation kindly provided by Mr. Jerry Choate, we were able to create a new Research Faculty position in the Departments of Urology and Biomedical Engineering. The establishment of the Jerry D. Choate Presidential Endowed Chair in Urology Tissue Engineering will insure that there will always be ongoing innovation and research as an endowed Chair continues in perpetuity. This position was supplemented by the Randy Douthit Tissue Engineering fund which will help insure that the researchers have the support needed to be successful.

However, the available funding is limited, and ongoing transformative research requires ongoing support. It is for this reason I sincerely hope you will contribute to our efforts. The following summarizes our main research interests. In the male, there are 2 diseases I commonly treat that are associated with damage to normal tissues leading to considerable disability – urethral stricture disease and Peyronie’s Disease.

Urethral Stricture Disease

A urethral stricture is an area of hardened, sclerotic and narrow urethral tissue. Urethral strictures can be induced by many factors, including trauma, (e.g. blunt force or penetrating trauma, urologic procedures or urethral catheterization), infection, hypospadias surgery (hypospadias is a birth defect characterized by diminished development of the urethra), and the treatment of prostate cancer with surgery and/or radiation. Urethral strictures can occur anywhere along the urethra, and range in length from less than ½ inch to over 10 inches. Patients with urethral strictures experience difficulty with urination often associated with a decreased quality of life. Other complications of urethral stricture disease include a complete inability to urinate, prostate infections, bladder damage, and kidney failure.

There is no effective medical treatment for urethral stricture disease. Surgical treatment options include dilations and internal incisions. These approaches are minimally invasive techniques that increase the size of the urethra and relieve symptoms. Unfortunately, these options generally provide only a temporary improvement and are considered a way to manage rather than cure the disease. In many cases, patients are managed with self-catheterization at a frequency ranging from weekly to several times every day in order to maintain adequate urethral patency and avoid total urinary retention. Currently, open urethral reconstruction offers the most effective definitive treatment for urethral stricture disease. However, this surgery is only associated with a very high success rate when preformed by a urologist who has completed a fellowship in male reconstructive urology and is specialized in urethroplasty. When the stricture is short, excision of the diseased segment and a primary rejoining of healthy tissue can be accomplished; this procedure is performed at our Center for Reconstructive Urology and and has an extremely low recurrence rate (less than 2%). However, in cases of distal or long strictures or hypospadias, the reconstructive management often requires the transfer of local skin as a skin flap, or the free transfer of distant tissues to supplement or replace the damaged urethra. In current clinical practice, penile skin flaps and both buccal mucosa (tissue from inside the cheek) and thigh skin tissue grafts are the most widely used materials for urethroplasty (i.e. repair of the strictured urethra). However, graft harvest can lead to significant pain at the donor site and other complications, and requires additional operative time.

Peyronie’s Disease

Peyronie’s Disease is an acquired disorder of penile curvature. For unclear reasons, an inflammatory and subsequent scarring process involving the substance of the penis (tunica albuginia) occurs, and this leads to shrinkage and curvature of the penis during erections. In severe cases, the curvature can be disabling, completely preventing sexual intercourse. The surgical treatment options include shortening the longer side to straighten the penis, but this can lead to significant forshortening of the penis and can also cause an “hourglass” deformity with associated buckling. Alternatively, the scarred area can be incised-excised and augmented with a graft to lengthen the shortened side and correct the curvature. Current graft materials used include dermis (tissue between the skin and fat from the abdomen) and veins from the legs (saphenous veins). The harvest of these grafts can be associated with severe scarring and pain at the donor site, and these grafts are structurally inferior to normal native penile tissue (tunica albuginia). Moreover, these grafts do not function as well as normal penile tissue. In particular, grafts may not “hold” the blood within the confines of the tunica albuginia during erections, and this is called a “venous leak”, resulting in rapid loss of an erection or complete failure to have an erection.

Tissue Engineering

When I use penile skin flaps or dermal, buccal musosa, or skin grafts, it requires damage and injury to completely normal and healthy tissues. Although I do this on purpose because these tissues are needed to replace or supplement damaged urethral and/or penile tissues, I would rather be able to instead use off-the-shelf sterile materials structurally and functionally identical to the urethral and penile tissues that require repair. This is the promise of tissue engineering.

The goal of tissue engineering is to supplement and assist the normal regeneration process of damaged or diseased tissues as an alternative to the use of tissue grafts and flaps; generally this is accomplished with synthetic or naturally occurring materials with or without cellular constituents. In the field of urology, tissue engineering is emerging as a viable option for replacement of ureters, bladders and urethras, obviating the need for harvesting grafts, a process that injures normal donor sites to obtain tissues that are different from the tissues being replaced and therefore these tissues may be prone to deterioration over time.

In general, those who have supported our efforts are my patients as they have personally experienced the suffering these disorders cause and want to contribute. If you are reading this, perhaps you or someone you know has suffered from urethral stricture disease or Peyronie’s Disease and would be willing to support our research efforts to that others in the future will suffer less, or not at all. All donations are tax deductable. I personally receive no direct or indirect salary support from donations or a salary from UC, Irvine for my participation in this research. Therefore, all contributions will be used exclusively for laboratory and clinical research and education. A contribution of any amount will be greatly appreciated.

Thank you for your support,

Joel Gelman, M.D.