Post Op Bladder restriction

Hey ~ Grover, During our post op visit Dr. Staley mentioned about the possibility of scar tissue.  He said if this should happen he would snip the area (procedure done at the office).  He did not come across as being a major issue... at least we didn't feel that it would be if we had to have it done. It's different when you have to have it done ~ so please... this is just information that we are sharing.... Also ~ including an excerpt from Dr. Walsh's book about this issue. Quotes & Partial Quotes…     ** Excerpts taken from a book titled…   “Dr. Patrick Walsh’s Guide to Surviving Prostate Cancer”…(Give Yourself a Second Opinion) Copyright 2001 Patrick C. Walsh, M.D. Professor of Urology, The Johns Hopkins Medical Institutions and Janet Farrar Worthington   Excerpt from page 253 Bladder neck contracture , or constriction of the bladder neck:   this is scar tissue that forms where the bladder neck is sewn to the urethra, and it has been reported in between 1 and 12 percent of men after surgery.   Its symptoms are usually manifested by persistent incontinence, and a very slow or dribbling urinary stream when –this is the tip-off—the bladder is full.   Remember, incontinence immediately after surgery is a very common problem.   In the early days after surgery, many men who are having incontinence also worry about having a slow urinary stream.   But it’s hard to achieve a good stream if there’s not much in the bladder—and it’s impossible to store up urine in the bladder if it keeps leaking out.   Bladder neck contracture is different; the bladder is full, but the best you can manage is a dribble, because the scar tissue is blocking the flow, like a stuck washer in a faucet.             If you are having prolonged incontinence, you should be evaluated with cystometry, a test that measures bladder progress and function by passing a small catheter through the urethra into the bladder.   Changes in pressure are monitored as the bladder fills with water.   If scar tissue is causing the trouble, it can be re opened in a simple outpatient procedure as a urologist, using a cystoscope (a tiny tube inserted through the tip of the anesthetized penis, through the urethra and into the bladder), makes a few tiny cuts to relax the tight scar tissue.             To keep the area open, your urologist may recommend that you pass a small catheter through the urethra every day for a month or so after the procedure.   This way, the scar tissue won’t re-form, and the normal lining of the bladder and urethra will cover the opening as it’s supposed to.   If the scar tissue is particularly stubborn, your doctor may inject a powerful steroid called triamcinolone into the area of the contracture; this can be effective in preventing the scar tissue from returning. END QUOTE   Hope this gives you a little guidance... We are glad you're staying close ~ continue to do so please ... so we know how things go for you. In Friendship ~ Lee & Buddy  

Uhh... Grover... I have experienced one of those strictures.  I do not have Dr. Walse's book. I have Dr. Peter Scaradino's book, however.

I can tell you my stricture treatment was nothing like the one described above my post. 

I went into the hospital as out-patient 3 months after open radical.  I was put to sleep.  He said he would either dialate, if possible, or cut it out.  I was dumb... again... and I did not read up on strictures.  Neither did my doctor attempt to talk with me about the subject.  What I discovered after the procedure (He was able to dialate) was that any procedure can cause even more scar tissue.  Moreover, the cutting can forever neutralize your last sphincter muscle.  I think it is not a simple procedure if you are the patient.

Please sit down with the doctor after finding out all you can  on your own and discuss your options.  To this day I remain incontinent after 8 months post-op.

The good news is that thus far, the stricture has not reappeared.  According to what I found out, often these things do reappear, causing more problems. As mentioned, I am still incontinent. 

I pray you have a successful outcome.

Gene 

Hello Grover,

My Hubby had his RRP in June 06 at age 54.  He had problems with the urethra 'join' not healing and had to keep his cath in for 12 weeks!!!  However, once he finally got rid of all that tubing (hoorayyyy) he's only had very minimal 'stress' incontinence and has never had to wear pads.  He had the same trouble you speak of with scar tissue restricting the flow.  His Doc recommended self catheterisation weekly but Hubby was having absolutely none of that and had to have first one and then a second 'bladder neck incision' to relieve the scar tissue.  After the second incision they didn't put a cath in (they did with the first one and it stayed in for 24 hours) and during the night after the procedure he went into total retention and we had to visit the ER at 3.00 am where they put in a cath for him.  However, all that was before Christmas and he's had absolutely no further trouble since.  Continence wasn't affected after both incisions either. 

Little Jem

Pujet,

I know you will keep close contact with your doc.  I tend to agree with you about waiting, but sometimes these things get so that they have to be dealt with.  In review, I feel the doc did the right thing for me because my stricture was staying irritated and bleeding everytime I walked a mile or so.  I am quite negative about him (he is my former uro).  He did not diagnose the stricture earlier even though I had symptoms.  He did not effectively communicate with me properly, although I (and insurance co.) paid him well to do so.  But I'm sure he did the only thing he could do and I had to have something done.  So just keep close tabs with your uro, and I know you will. 

Gene

I read the post "reason for my continued incontinence-stricture" and find that I'm not alone. Havent got to talk to the doc yet but meanwhile I've eliminated coffee, beer and tomatoes from my diet and my symptoms have improved. While I may have some urinary blockage due to scarring, I wonder if the penis pump I recently tried may have aggravated my condition? I only tried it once and didnt like it but I'm wondering if the suction it creates somehow pulled at my urinary tract and caused it to swell ?? ( If you havent guessed, I'm a retired engineer and we are always analyzing things ) This is just a thought to anyone who may be using the pump that it may be part of the problem.