Urethrotomy

I developed a complete blockage stricture at the bulbous in March of 2019 after HDRB and IMRT in 2018, not sure if it was caused by the treatments though.
The urologist performed DVIU which was a bit painful and three days of catheter. So far so good. From what I read, this thing will come back again. Surgery is an option which will reduce the chances of the stricture coming back.

Deon124 said...
I was diagnosed with prostate cancer 2016, followed by a radical prostactomy
Now May 2020 had to had a Urethrotomy due to narrowing at original stiching
6 weeks after op. Same problem . Doctor wants to do another Urethrotomy followed by self catheterisation.
I am 47
3+4
PSI 0.02

The timeline is unclear to me.

Six weeks after the RP there was a narrowing? Was a procedure done then to open it?

Was there a narrowing at 6 weeks post op but, nothing needed doing until 6 weeks ago?

We’re you not aware of any narrowing until 2020?

If you were not aware of any narrowing until 2020 and the first opening was 6 weeks ago, that means...the first opening was actually done in April of this year...correct? And now, in May it has closed again. Correct?

This isn’t meant to jerk you around. I had a narrowing 6 mos. after RP. (It has not closed back up). So, I’m just trying to understand as best I can because, fwiw...this would be the first I’ve ever heard of a stricture first making itself known as long as 4 years post RP.

I can only hazard a guess as to why your uro wants another procedure before self-cathing. He may be going for a cure by opening it and then having you dilate it until the wound heals (open).

You are young. You could be looking at 40 years of self cath. You might think about going for a cure.

Hi Yes I had a the radical prostactomy 2016

It really only appeared to me that there is a problem the last few months. 2020.

Post the radical prostactomy I did not observe any problems.

The narrowing was only discovered now in April 2020 . Did the Urethrotomy and now 6 week during the follow up visit to the doctor post Urethrotomy noted it closed again.

So yes not sure what to think. I also doubt that so long after the radical prostactomy that suddenly the stricture making itself know. Maybe it was there all the time.

But I don't see the point to do the Urethrotomy again. According to him this is the only option. But if it lasted only 6 weeks it will probably take 6 weeks again or something else going on.

Deon124 said...
My surgery was done 6 weeks ago.
Not sure it is worth doing it again, if it only lasted 6 weeks.
Maybe just self catheterisation. Any opinion on this ?

urethroplasty surgery is a very good option. It's supposed to be the 'gold' standard for fixing strictures.
I had it done myself for a stricture at the end of my waterworks 2 yrs or so ago.
My stricture was indirectly caused by prostatectomy complications - the catheter (or instrumentation damage) during surgery did a number on me.

It has worked well for me ..... 2 yrs or so now I haven't had to daily manually self-dilate to keep it open. It's not minor surgery and only some urologists are 'certified'/qualified to do it. I'd recommend you look into doing this but research your specialist well. ie. One that has significant experience in doing it. There's some technical skill in doing it and you don't want to be the first.

akai said...
Hi Jasper, can you please share more info of your experience on urethroplasty, where you had it done, how long it took, how long did it take to heal, anything one should look our for, etc.
I know that eventually I may also have to go through the same for a more permanent to my stricture issue.
If you want, you can email me direct.

thanks,
Akai

Akai, I had mine done in Australia. If you're in this part of the world, let me know and I'll pass on the details.

First thing is, do it !!!
It's changed my life. I was manually dilating every 2nd day or so and not pleasant plus continued dilation does eventual damage itself many say. Now I have great flow (better than before all these issues, lol.)

The surgery is major - took 2+ hours for me believe. I only needed 1 overnight stay for observations. You may need longer if you're at home by yourself. The surgery for me involved 2 specialists - one who harvested the graft from my mouth, the other who repaired the urethra with the graft. It's possible you can find 1 guy who does both ?

No pain issues on waking up. My mouth never bothered me where they took the graft. First 2 weeks I ate very soft food - and avoided that part of the mouth ! But absolutely no issues for me there. It healed fast and no consequences.

They put a catheter in and removed it 2 weeks later. No pain from catheter which is weird given the major work they did 'down there'. My stricture was at the very end. YOu will need to wear very loose clothes around the house for the first month (if your stricture was at the end) to avoid touching/brushing/bumping suture site. By a month all is better but you still need tight clothes to avoid (much)movement if you're exercising. But this all steadily gets better.

After I had the catheter out (2 weeks), flow was good but it even got better about 6 weeks later again when urologist inserted a small catheter like device to test the opening. That must've cleared out some scabbing or debris from the surgery, because immediately after flow was even better.

Flow is better than before I had my prostate removed. It could not be better, so I really recommend it.

Hi Jasper, just came back from my urologist's office, the cystoscopy shows that my stricture at the Boulbar is back, we saw white spongy material narrowing my urethra and he was unable to pass the scope through it (not sure if he even tried).
I have two choices, repeat the urethrotomy which is a temporary treatment or urothroplasty which is a more permanent one.
The problem of urothroplasty is finding a skilled and experienced surgeon, my urologist does urethroplasty but I not been able to find much information on how many or how successful he has been.

MP

Jasper, the urologist that I am seeing is supposedly a specialist in reconstructive in this area (urology), he has been practicing in this field for about 15 years.
However, one of my concerns is that by Radiation Therapies (HDRBT and IMRT) will have a significant effect in the healing process, lowering the success rate of the surgery (per study).
The only option left is to repeat the urethrotomy, and as known, the length of its effectiveness lessen each time the procedure is performed. I am quite stressed as there is really no good solution.

And thanks very much for your response and advice.