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Returning Urethral Structire

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Posted 4/12/2016 12:35 PM (GMT 0)
I had a Urethral removed by urethrotomy last September, 12 months after salvage radiation. Uro had me self catheterizing on a daily basis, meant to drop down to weekly with a month or so. Stricture seemed to come back quite rapidly, so never quite got to once weekly, and now back to daily as I am just about completely blocked.

Uro seems to want to go for another urethrotomy, but I am wondering if I should just bite the bullet and go for a Urothroplasty. Assembling some medical opinions, but wondering if there are some real world experiences/opinions I can call on here
Posted 4/13/2016 12:04 AM (GMT 0)
I think you know more about this than anyone here AlanB…certainly myself. The metrics of your Pca journey are excellent imo
Posted 4/13/2016 3:12 PM (GMT 0)
bump
Posted 4/13/2016 3:52 PM (GMT 0)
I developed a stricture post surgery and was prescribed a similar course of action.

I had a cystoscopy with a balloon dilation (very painful) followed by 30 days CIC (self-cath). I made it to 30 days and the CIC was causing more harm than good so I was ordered to stop. Within a couple weeks I was back to almost no flow.

Then had a DVIU (urethrotomy) laser ablation and that so for has done the trick for about the last 8 months. I understand long term success rates are really not that great but it depends on your case.

After the DVIU my uro was optimistic. The stricture was relatively small and he felt he got down to healthy tissue. Based on this he thought my long term odds were pretty good. If I went at least a year before having an issue again he would likely repeat the DVIU before jumping into a urethroplasty.

Any idea of the size and location of the original blockage? How long did you go after your urethrotomy without any issues ? If it's been a while might be worth another try but this is based on my case so it may not apply to you.

Jon
Posted 4/14/2016 7:29 AM (GMT 0)
I was having issues within 3 months of the op. The original stricture was a bulbar. Not sure of the size. The current situation is that the stricture appears to be approx 20mm and again quite close to the bladder. I think I have a smaller stricture just before the main one
Posted 4/14/2016 8:11 AM (GMT 0)
In spite of major retention issues, I haven't been down the urethrotomy or urethroplasty routes. That is because it was not certain that a stricture was causing the retention. It may have been due to sphincter nerve damage and I also had major continence issues. Fixing the retention issue may then have resulted in a major continence issue.

To overcome the retention propblem, I now have a suprapubic catheter which is probably there for life. If you are not able to resolve your stricture problem you could end up in the same place.

While it isn't ideal, it is quite manageable and in my mind preferable to permanent incontinence.

Hopefully you can resolve the issue without going down that track, but If you need more detail about the SPC, I can help.

Chas
Posted 4/14/2016 1:44 PM (GMT 0)
AlanB - Let me stress I'm not a doctor just some guy on the internet.

This is my understanding from interactions with my doctors and what I have read.

The success rate of a secondary DVIU is lower than the first procedure. You were closing up pretty quick after the first one (3 months) and a fairly large stricture (20mm). I think this makes an additional DVIU less likely to succeed long term for you. On the other hand a DVIU is a fairly easy procedure to recover from so why not try it.

Sorry I can't be of much help. I think all I have done here is re-state the reason which brought you here in the first place. Should I or shouldn't I... Hopefully those more knowledgeable will continue to chime in with advice.

Best of luck in what you choose, please let us know how it turns out.

Jon
Posted 4/15/2016 11:47 PM (GMT 0)
I had stricture issues before PCa. In the late 90's I had urethroplasty surgery after years of flow issues treated by dilation. After the surgery I had about 8 years with no flow issues then the flow slowing issues returned.

After my cancer and RP treatment I had to return to dialation or laser treatments about once a year. My urologist has recommend another urethroplasty but frankly I do not want to have another major surgery to this region of my anatomy. Unless things have changed in the last 20 years for me the urethroplasty was more invasive, painful, a longer stay in the hospital, longer with the catheter and longer recovery time when compared to my RP treatment.


TG
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