BackTable Urology
Ep. 289 Insights into Urethroplasty & Reconstructive Care with Dr. Benjamin N. Breyer
10 Feb 2026
Chapter 1: What is the background of Dr. Benjamin N. Breyer in reconstructive urology?
This week on the Backtable podcast.
Even yesterday, I did a case where I was a little bit deceived by the rug and it turned out to basically be a membranous, a short membranous stricture and a heavy guy. You know, BMI probably like 38 or something along, maybe that's for you guys.
Yeah, in Ohio, I'd love some 38s. Teasing.
Chapter 2: How have surgical techniques in urethroplasty evolved over time?
But yeah, so like all of a sudden we're in there and he's youngish and so his good vasculature, it's not, you know, dry. And all of a sudden you're like, okay, this is, we're doing a case here. And it wasn't exactly the case that I had envisioned.
And so if you don't have exposure to that, if you don't have the experience, I think sometimes that kind of thing could be hard for someone in practice to manage that or even want to manage that.
Welcome to Backtable Urology, everyone.
Chapter 3: What challenges arise when managing complex urethral stricture cases?
I'm George Koch from The Ohio State University, and I'm really excited today to introduce Dr. Ben Breyer from the University of California, San Francisco, to discuss kind of all things urethral reconstruction. Dr. Breyer, thank you so much for taking the time to speak with us today. George, thanks for having me.
Before we get into urethral reconstruction specifically, I was wondering if you could tell me a little bit about your path to becoming a reconstructive urologist.
Chapter 4: How is education and training in reconstructive urology changing?
Yeah, I think I was really fortunate to be a resident at UCSF where Jack McAnich had his practice. He's one of the seminal figures in the field. And it wasn't clear to me that I actually was gonna do female urology. And it's a love story. It turned out that the person who's now my wife, and I were dating and I didn't want to do a long distance relationship.
So it kind of removed female urology from the table. But I've always kind of been interested in quality of life and quality of life surgeries. And I think that and then the creativity that's associated with
Chapter 5: What does the future hold for reconstructive urology?
Reconstructive Urology. Those were the things I think that drew me to the field. And then having Dr. Mackenich have a willingness to take me on as a fellow was great. And I had an interesting thing because he had already matched. So I had to take a year and be a junior attending. But it also gave me an opportunity to do a master's in clinical research before then doing his fellowship as a PGY-8.
It was a great experience.
Chapter 6: What are the challenges faced by urologists in rural areas?
It was a lot of fun.
I mean, you're one of it feels like hundreds of folks who have had some sort of like McInnich connection or McInnich mentorship. And I mean, even me as a former University of Washington fellowship from Dr. Wessels, from Dr. McInnich, I mean, it it's You're a grandchild, yes. Exactly, exactly.
Chapter 7: How is patient access to reconstructive care being addressed?
People would just talk about him so fondly. You know, training under him must have been, I mean, I can't even imagine what it was like. It must have been so special.
It was special. He's just such a sweet and well, he's brilliant, but he's just such a good person, such a high integrity person. I mean, I've had a lot of really incredible mentors here at UCSF and lean on all of them still, but spending that clinical year with Jack was really special. And then it led to me being hired and being his protege, which, you know, those aren't shoes you can fill, but
having him around, you know, he's still working all these years, like 15 years later is it's been a blessing. It's been really awesome.
Yeah, no, no. I mean, as you know, you know, here in Patel, your former fellow, my my partner here at Ohio State talks about, you know, him just kind of popping into the operating room and and saying something really insightful and, you know, to be able to kind of teach at that level where you can see a case for 10 seconds or 30 seconds and like,
progress someone without touching the patient, I think is so, so cool.
Yeah, no, he's, he's a special guy.
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Chapter 8: What innovations and research are shaping the future of urethral reconstruction?
She said, just had breakfast with him.
Oh, wonderful. Love it. How, you know, you talk a little bit about being at UCSF for, you know, the, the duration of your career then, and being under Dr. Mac and itch and now, you know you yourself are a giant in reconstructive urology how have you seen your practice evolve from the early career and kind of how he practiced to kind of how you're treating patients now
Yeah, I think there's definitely been, my practice is different than Jack's. You know, when I took over, I was just starting and he was at the tail end of things. So I think we did get a little busier right away. And then I had the opportunity to inherit this big quaternary practice that he'd built for decades. And so got to care for all of his old patients.
It had all the referral networks kind of built in. They knew that UCSF was a place to go for reconstructive care. I think one of the things that I'm interested in that he did less of is sexual medicine. So I do a fair bit of Peyronie's and surgical sexual dysfunction care, so implants.
pretty much do all the stuff that he did dabble in the abdomen do mostly kind of perineal surgeries do a lot of cancer survivorship surgeries prosthetics do a ton of buried penis in a lot of ways the practice and what we do is similar but in a lot of ways it's really evolved and and changed i think we do far fewer anastomotic erythroplasties i think we're doing
probably a fewer buccal urethroplasties than I did, say, 10 years ago in favor of non-transsecting urethroplasties.
Yeah, and that was one thing that I really wanted to get into as we kind of start to narrow down on urethral reconstruction is how you've seen the process or you've seen the pathways change from Dr. McInnich to your procedures and then how you've seen them change even over the course of time.
So you feel like less, you know, it seems like it kind of went in anastomotic to buckle back to anastomotic, but without a transection. Is that kind of what you're describing?
Yeah, I think that's accurate. I think for me, other evolutions in my practice have been around radiated patients. I'm definitely less aggressive with radiated strictures than I had been when I first, you know, in those first five years. I still do urethroplasties, those membranous intraprosthetic strictures that we find after radiation.
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