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Here we go - Second follow up ? about strictures

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Posted 1/12/2018 3:34 AM (GMT 0)
Hey guys (and gals)...I'm scheduled for my second visit to the Uro after my RARP. I've got a few issues that I want to discuss with the doc. I'm pretty sure I've got a bit of a stricture in my urethra somewhere. I can get a small stream sometimes but mostly just dribbles. I don't seem to have a problem emptying my bladder. No pain but it does seem to "splatter" everywhere if I'm standing. I've complained to my wife about having to sit to pee and she says; "And...what???" rolleyes I guess I get that it's not that big a deal but I do realize it is something for the Uro to address. I'm also wondering if that is effecting my continence. I know it's only been 16 weeks and I'm dry at night so I'm not sure if it matters.

That said, what questions should I be asking the doc about the potential flow issues? I appreciate your input.
Posted 1/12/2018 4:39 AM (GMT 0)
This from UCLA’s webpage on urethral stricture:
Treatment Options
Treatment for Urethral Stricture
The retrograde urethrogram and antegrade urethrogram are imaging techniques that can help to pinpoint the length, position, and severity of the stricture. This also helps to guide the treatment course. Among the many approaches to treating strictures are gradually stretching them, a process called dilation; cutting the stricture with a laser or knife using a specially designed cystoscope (urethrotomy); and surgically removing the stricture and then reconstructing the area with grafts (anastomotic urethroplasty). The choice of treatment depends largely on the severity of the stricture. In minor cases in which the complication risk is low, doing nothing may be the best option; more moderate or severe cases are best addressed using either a minimally invasive or open surgical approach.
MSK also has a page, you can google it.
Posted 1/13/2018 2:44 AM (GMT 0)
Congratulations on the on the good path report. I had some problems with retention post-surgery. You might expect to have a cystoscopy, a procedure that the uro performs in the office. He or she runs an instrument with a lens at the tip up the urethra. That way they can see exactly what is going on and what kind of obstruction there might be. To solve my problem I had a dilation procedure; they run progressively larger tubes up the urethra to stretch it out. In may case that worked.
Posted 1/18/2018 4:39 AM (GMT 0)
Thanks for the insight. I'll have a few questions for the Uro. I don't think this is something that needs to be addressed right away, however, I'll leave it to him.

I did have another PSA done (1/16/18) for the upcoming appointment and the came back as <.01 ng/mL so I'm really happy about that. So it is time to work on the quality of life stuff...continence and ED.
Posted 1/18/2018 5:54 AM (GMT 0)
Congrats on the <! May you never be detected!
Posted 1/18/2018 12:23 PM (GMT 0)
I would not ignore issues with emptying your bladder. I've had some pretty ugly strictures that led to 2am emergency room visits from no problem at 10 the night before.

Keep your uro / surgeon in the loop, and get their feedback on how you should handle issues. I can testify that some ER docs are not the best at inserting and managing catheters.
Posted 1/25/2018 6:19 PM (GMT 0)
Had my follow up yesterday and the Uro is pleased with where I am. Second <.01 PSA is a good start and he was not concerned about the continence.

Uro thinks the amount of leaking I'm having during activity (not sitting or laying down) is normal. He did refer me to PT for some kegel training other assessments but said it "could only help not hurt." He also thinks the ED part is on track as well. Said to up the Viagra take to 2X a week regardless of activity. I think this has more to do with my insurance (free viagra but no cialis) and he thinks that ideally I will be able to taper that as time goes by.

Regarding the possibility of strictures...he scheduled a scope to see the extent of the issue but after examining me he thinks it is scaring at the tip. Once he does the scope his plan is to possibly use some minor dilation and wants to stay away from more invasive activity if possible.

All in all, I think it was a positive visit and more assured about my progress to recover. Plus, that's an awesome PSA score so what's not to like!
Posted 1/25/2018 7:55 PM (GMT 0)
I have to second 142, strictures are no good. Often they increase and cause an urinary retention which gets you into the emergency room.

They are difficult to treat as Saipan paradise described. A "minor dilation" will cause pain and only help temporarily. You will have to get an urethrotomy. In 30% of the cases, however, the stricture will return and you have to have a second urethrotomy. There are doctors that keep on doing this, but the recommendation is that you get an anastomotic urethroplasty after the second urethrotomy.

I hope you can live with the current situation for a long time. Using a catheter can increase the stricture again.

George
Posted 1/25/2018 11:24 PM (GMT 0)
Tiger88,

Is your stricture at the anastomosis, or is towards the end of the penis? The reason I had same symptoms caused by fossa navicularis stricture near the tip of the penis. It was caused by abrasion of a catheter that was to large. I had total blockage and required dilation, which WASN'T nice. Urologist told my to dilate the stricture at least twice a day for the next several weeks, then daily for the next several weeks, the less frequently. Over a period of two months I was able to completely eliminate this stricture. The first week was very painful, even with lidocaine jelly.

The goal is to stretch and relax the scare tissue. My urologist told me the alternative is surgery which doesn't have a pleasing outcome.
Posted 9/9/2018 2:39 PM (GMT 0)
Sorry for the delay in replying. Yes, my stricture (partial) was a the tip. I never had a problem emptying my bladder but it was a lot of spray at first then a stream.

The URO did do a stretching procedure and it made a difference. My URO commented that he does not think I'll need another "stretching" but said I should come in if the stream tapers any. He did the cystoscope after stretching and there were no issues with that.

It also seems to help with pad usage. I've cut my pad usage in half after the procedure.
Posted 9/9/2018 2:50 PM (GMT 0)
That's a good report.

Hopefully it will be one and done.

Andrew
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