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Dilation for Stricture

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Posted 4/24/2012 3:19 PM (GMT 0)
Well it's going on seven months post RALP surgery and I could not have asked for a better outcome, no incontinence, ED was non-existant and I was back to just about normal in that department without drugs pretty quickly, PSA is non-existant. The only difference I saw after surgery was a split urine stream at times and some pressure in my urethra when holding urine for a long time and really having to urinate, like after several beers. I thought it might be from no longer having a prostate and better flow so I didn't worry about it at first then mentioned it to my Urologist, he said if it continues or becomes painful or bothersome let him know. Several weeks after my four month PSA and return visit I called his office and he scheduled a cystoscopy and possible dilation.

Well when the technician came in to insert the numbing gel he mentioned the stricture feels like it is towards the tip of my penis. The doctor came in, skipped the cystoscopy and said he can tell the stricture was near the tip. I was glad the cystooscopy was skipped and the stricture was near the tip. He proceeded to ask for some long knitting type needles  :-)  , well thats what they look like, I asked if he was going to re-film Braveheart again with those midieval tools and me as William Wallace. After a laugh we proceeded with the dilation, going from a smaller diameter to larger he could feel the stricture open up very close to the tip. It was'nt that bad of a procedure until the very last dilation tool I felt a little stinging. Afterwards I had a little blood and stinging for the first few urinations but everthing was flowing better with no split stream. So far everthing is going well with the stream but at times when urinating very hard I get some pressure in the urethra and not a split stream but just a little spray for a second or two. My urologist has talked to me several times to follow-up and said keep an eye on it and if it get's painful or starts to slow down to a dribble to let him know, he mentioned he could do a cystoscopy to check things again and then if needed do self-home dilation which tends to be a better option in the long run.

Hopefully I don't need to go through the procedure again and luckily the stricture was near the tip, which may have been caused by having the catheter in place after surgery.

Just wondering if anyone else here has experienced the same type of issue, procedure, or what you may have needed to have done in the long run?

Thanks

   

Posted 4/24/2012 4:04 PM (GMT 0)
I had restricted stream and intense, frequent urgencies (only to have almost nothing come out) with no relief from a catheter (couldn't fully insert). Turns out my "stricture" was a flap of cancerous skin closing over the urethra at the neck of the bladder! That was snipped away by my urologist, and I had 80 grays of radiation to resolve the bladder-limpet cancer tumor. Hopefully the "cyst" or whatever is causing your stricture is benign (but I am sure you will be watching it closely for abnormalities).

Since your stricture is near the tip of your penis, you at least do not have bladder/urethra strictures more common with PCa.
Posted 4/24/2012 6:41 PM (GMT 0)
My treatment was cryo / freezing.
I believe that the catheter I had was installed incorrectly or something. I had bad pain in my penis with catheter. After the catheter came out I had 9 weeks of pain and blood in urine. Had to sleep on my back for 2 months. I let it heal on its own rather than getting treated again in the urethra.
Still have occasional t mild twinges of pain in the penis but nothing bad. My urine flow is now OK. I do take alfuzosin to help with flow a little.
Good luck.
Posted 4/24/2012 7:52 PM (GMT 0)
Two months after having a RP I developed a stricture severe enough that I was admitted to hospital and had a procedure to open up the blockage. I think they just surgically reamed out the urine tract. I was kept one day with a catheter inserted. Catheter was removed and went home with good urine stream. Two months later urine flow started to slow again. Had a cystoscopy and had progressively larger tubes inserted to dialate the urine tract. It has been 13 months since then and no issues have resurfaced. I think the strictures may have developed as part of the healing process.
Posted 12/10/2015 8:41 PM (GMT 0)
yowsa.........just had this down a the doctors office yesterday. Very similar set of circumstances but I am only 5 weeks out. I guess it is better to get this out of the weigh now rather than down the road a few more months. Not pleasant at all. Sent me home with self home dilation materials.....yuck

once a day for 2 months, then once every other day for 2 months, and finally once a week for 2 months. Should get pretty good at it over a 6 mo stretch.
Posted 12/10/2015 9:47 PM (GMT 0)
What you are describing is a Fossa navicularis stricture which occurs towards the tip of your penis. Mine was about 1/3 to 1/2 inch from the tip. Typically it is caused by the catheter, and usually a catheter larger than 18 french.

This can be very problematic, and worst case scenario is surgery which can disfigure your penis. After hearing that I figure I need to deal with the problem and take ownership of it.

Mine occurred about 3 after the catheter was removed, it occurred fairly quickly and finely was totally blocked. The first time I went to the urologist and the medical assistant dilated it, which was painful. Well in less then 2 weeks it occurred again and this time the urologist dilated it. Even though he squirted some lidocaine jelly in the urethra and waited about 5 minutes, I screamed like a baby. It was like tearing a wound open.

The urologist gave me a soft plastic dilator which looks just like a chopstick and a RX for lidocaine jelly. He told me to dilate at least twice a day. I would squirt a little lidocaine jelly into the urethra wait five minutes and slowly insert the dilator past the stricture. At first it would take 5 or 6 minutes, after a week it took less time and after a month it took less than a minute. After about 4 weeks, then I would do it every other day, and as time past I would do it only couple of times a week. After 2 months the stricture was relaxed and required no further treatment. I would leave the dilator in for about 5 minutes to help relax the stricture.

You want to be gentle at first to minimize any additional trauma, and there can be some bleeding. When the urologist dilated my I bled like a stick pig for a while which looks far worst than what it really is.

Bottom line, if you don't deal with this, it will be an ongoing problem and very probable leading to surgery.
Posted 12/11/2015 12:57 PM (GMT 0)
lapilot........that is exactly what I have.

The dilation in the office was definitely painful. The self dilation at home is less so but still very uncomfortable.

I was instructed to dilate only once a day. Do you think it would be beneficial to increase it to twice a day? How long did the bleeding last? Today was only day 3 including the dilation perform by the urologist and am still producing blood after dilation.

He did not prescribe or use lidocaine jelly, only KY. Did the lidocaine make a big difference?

Also was not instructed to leave the dilator in for any length of time, only to insert it once a day.

Not real sure how far to insert. Currently going in slightly past the glands and it is producing blood so I assume I am inserting to an ample depth.

Thanks for your input
Posted 12/11/2015 11:17 PM (GMT 0)
Fripp Island,

The lidocaine jelly did help initially (first month). The first week I had a little bleeding.

You want to get the stricture to open up (relax), right now it is like a taught "o-ring" or rubber band. My urologist said the longer you leave it in the better, and do it at least twice a day. I found that after 5 minutes of the catheter being in, I am able to pull it out and then back in without much trouble or pain showing that the stricture is relaxing for the moment.

As for how far to go in, my dilator was just like a chopstick, so I would put it in far enough where past about a 1/3" past the stricture with the full diameter of the dilator. BTW, my dilator about 8"long with the fullest diameter about 1/4" (0.235"), at about 2.5" from the pointed tip. So I would insert it about 3" from the tip of the penis.

You want to be gentle and slowly. The stricture is scar tissue and you don't want to create any additional tearing or scaring. I found if you slowly rotate the dilator when you get to the stricture, it pass through a little easier.
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