Urinary Strictures

Reviewing past posts, and looking for input and experience with strictures, that cause problems with urine flow. Strictures are scar tissue that form around the re-attachment site of urethra and bladder and can impact flow. It evidently happens to only a small number of us, and I am one of the "lucky" ones.

Here's what I've got so far...

RALP successfully completed in Sept 14. Catheter in for 14 days, and at this point everything looked really good. Pathology confirmed G7 (3+4) but margins were clear, and 90 day follow up PSA was <0.1. I was really pleased to be one of the lucky ones with incontinence, as I was essentially dry from the first day. I did lots of Kegel exercises for 3 months prior to surgery, which I think prepared me well. ED isn't of big concern for me at this point (yet) .. I am probably at 40-50% in that area.

My current issue now, isn't leaking or incontinence, but rather that I am struggling with enough flow. Irony is sometimes cruel :)

Early Dec (90 days post surgery), flow was reduced enough that I went back to Uro. He did a scope and confirmed stricture. Process to open it up 2 days later was outpatient but under anesthesia - he described it as cutting slits to open the scar tissue, and inject with steroids to inhibit regrowth. Big issue for me was that I needed catheter again (!) for another week.

Uro was surprised to find that one of the surgical clips had migrated enough to impact urethra, and he attributed this as a cause of the scar tissue. I have found references to this on-line and evidently clips are prone to migrate in some cases. Anyone else had or heard of any issues with surgical clips, like this?

Catheter from this procedure came out Dec 18, and flow was great. But now, here we go again. Flow is significantly diminished again, in less than 30 days. I had Uro appointment last week (Thurs 15th) and scope again (ugh) to confirm scarring again. We will now repeat the procedure to open up once again, scheduled for next week Fri (Jan 23) - outpatient but full anesthesia, and will have catheter (for 3rd time) for another week.

The decrease flow has come on quite quickly, so this schedule presumes that I won't completely block in the interim, and then require a trip to ER.... I'm optimistic that I'll make it to Fri, but we'll see.

So, what the heck is going on here? Issue with surgical clips is resolved, says my Uro. But scarring is back in less than 30 days, and has this substantial impact? My Uro says, in all of his patients, he has a very small number with strictures, and a much smaller number (handful) that have needed correction procedure more than once. And, he says that he has never needed to correct more than twice?

Can I be optimistic at this point? Are there other correction strategies that I should be thinking about now, or later? Purgatory has had a very challenging path with this, and I can't help but be concerned about future prognosis. What do you think?

pkretz, you have my sympathies. I too am experiencing retention, but in my case it is complicated by the fact I am also incontinent!

I know that sounds like a contradiction in terms, but it's where I'm at right now.

I won't bore you with my whole story, but the fact is sometimes I can't pee at all and at others I leak like a seive, and the worst part is that from day to day, I never know which will prevail, though over the last couple of weeks retentativeness seems to be winning. Luckily my suprapubic catheter takes care of that.

To address your original issue, there are basically 4 options for fixing strictures, 1) dilation, which I have had and which is rarely successful in the long term, 2) Urethrotemy, which is what you had, which seems to have mixed results, 3) Stents, which doesn't seem to be done much these days and 4) Urethroplasty which is where I am likely headed. As listed, the degree of complexity/invasion increases with each treatment.

For more detail see
http://www.medicinenet.com/urethral_stricture/page4.htm
or
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2585709/

It's not a pretty picture, but hopefully your latest treatment will see you peeing like a horse so you can put all this behind you.

Good luck

Chas

Stents, for a solution, can be problematic. My surgeon said, trouble with stents, is that can grow into the tissue and become imbedded, and then not work, making it difficult, if not impossible to remove the stents, even with additional surgery, making the problem even worse. One reason some urological surgeons pass on using stents.