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Of the 313,000 men in the United States diagnosed with prostate cancer each year, about one-third choose some form of radiation therapy. Although these treatments are highly effective for localized cancers, they can sometimes injure surrounding tissue, causing temporary urinary issues. In rare instances—perhaps 1 percent of all cases—damage to the urethra, the tube that empties urine from the bladder, can be painful, debilitating, and difficult to remedy.

That was the case for Robert Ott, a plumber from Pennsylvania who underwent radiation therapy following a radical prostatectomy in 2013. “I had every kind of complication you could have,” says Ott, now 60. The therapy scarred and narrowed his urethra, making it difficult to urinate. Over the next decade, Ott underwent numerous reconstructive surgeries, but none provided a lasting fix. Urine began leaking into his pelvic bone, causing intense leg pain and severe swelling that reduced his normal gait to a slow shuffle.

For prostate cancer survivors with severe urethral damage, the treatment of last resort has been to remove the bladder and divert urine from the kidneys to an ostomy bag attached externally to the patient’s abdomen. But Ott, an avid outdoorsman, worried about the lifestyle limitations of this approach. His wife, Emily, a registered nurse, urged him to delay the decision.

Then, Ott’s longtime surgeon offered him a different and far more appealing option: a robot-assisted technique aimed at repairing the radiation damage. Lee C. Zhao, MD, director of male reconstructive surgery at �����о��� Langone Health and a member of Perlmutter Cancer Center, had devoted a dozen years to formulating a more effective solution to this condition, whose ravages he’d first encountered as a resident. Finally, he and Jamie P. Levine, MD, chief of microsurgery in the , developed an approach that could revolutionize future treatments for patients like Ott.
The minimally invasive, two-stage surgery uses tissue from the small intestine to rebuild the patient’s urethra, with the goal of restoring urinary function and quality of life. “Mr. Ott had been through so much, but he was still relatively young and healthy enough that we thought he could benefit from this approach,” says Dr. Zhao, who holds a dual appointment in the and the Hansjörg Wyss Department of Plastic Surgery.

Ott knew he could trust the team at �����о��� Langone, whose Department of Urology is tied for No. 2 in U.S. News & World Report’s Best Hospitals 2024–25 rankings. He agreed to be the inaugural patient to undergo the procedure.

On July 27, 2024, he was wheeled into an operating room at Kimmel Pavilion, joined by Dr. Zhao, Dr. Levine, specially trained support staff, and two different robotic surgery systems. One robot, a massive device called a da Vinci SP, leverages Dr. Zhao’s internationally recognized skills as a urologic reconstructive surgeon, enabling him to operate deep within the pelvis with a precision beyond the capacities of the unaided hand and brain. The smaller second machine, by Symani, enables Dr. Levine, a renowned plastic surgeon, to dissect and reattach microscopic blood vessels in the harvested tissue and its new home.

Working through inch-long incisions in Ott’s abdomen and perineum, the team cleared away necrotic tissue, then carefully removed an 8-inch segment of intestine, using part of it to replace the damaged portion of the urethra and the rest to fashion a passage to the abdominal wall. This allows urine to be diverted via a catheter until the urethra had healed. The complex procedure took 17 hours to complete, and Ott was discharged five days later.

“These patients have had no good options,” says Dr. Levine. “This is a truly unique surgical solution that had not existed before.”

Ott is currently overseeing construction of a new home, where he and Emily plan to spend their retirement. “For the first time in years, I have no pain and no trouble walking,” he reports. “It’s amazing to be able to do normal things and not have to think about it.” Later this year, Ott will undergo the procedure’s second stage, aimed at permanently restoring his ability to control urination.

Four more patients have undergone the reconstructive procedure since Ott, all successfully. “I’m very gratified to have a solution to offer these patients,” Dr. Zhao says. “And we couldn’t have done it without the culture of innovation and collaboration that exists at �����о��� Langone. By working together, we’re able to make one plus one equal more than two.”