I was diagnosed with phimosis and BXO in 2015, at age of 30. Initially treated with steroid cream which did relieve the symptoms, but only temporarily. Circumcision was performed that year with success, restoring my sexual functionality.
Seven years later, I am 37 and diagnosed with meatal stenosis and BXO spreading onto the penis. I have a bit of dribble after urination, and somewhat weaker than average stream, but nothing serious, painful or debilitating. Picture below.
This is from the letter from my urologist:
*You have done a flow rate today passing 360mL. Your Qmax is 20mL/second which is perhaps a little bit slower than I would expect in someone of your age. You have no significant post void residual. *
*On examining you today, your urethral meatus looks stenosed so I propose to dilate this and also examine the rest of your urethra with a cystoscope. I have explained that, should I find any further strictures, we may teach you to self-dilate regularly to keep the narrowing from reforming.*
I sought a second opinion, and the other urologist also recommended a cystoscopy and dilatation, followed by self-dilatation. Having considered this, **i have a few concerns**.
1) **First, cystoscopy seems like a rather radical procedure for the relatively mild symptoms I have, and the low chance of having urethral strictures** deeper inside. The second urologist noted that there is 3-5% chance that BXO has spread inside the urethra, and this is the reason for the rigid cystoscopy to be performed, as well as dilatation, if needed. The cystoscopy would be done under a general aesthetic, it is a painful procedure, and recovery takes time.
2) Second, the second urologist noted that **dilatation creates scarring which tends to lead to renewed tightening of the urethra, and repeated need for dilatation**. Self dilatation also carries the same risk. Online research confirms that. Overall, it sounds like this could do more harm than good, and even the cystoscopy itself could lead to scarring and strictures, even if my urethra is perfectly fine.
3) Online resources suggest a **meatotomy as a preferred procedure**, as it does not create the kind of chronic damage to urethra that dilatation does. Meatotomy is basically cutting the meatus open without stitching. Wouldn't it make sense to do this instead, followed by perhaps some steroidal cream treatment of the meatus? If my slight issues with urination remain or worsen, I would then consider a cystoscopy, as
Any thoughts on this? I would add that I am also insured and am using private clinics, so I worry that the doctors may be after the insurance money, assuming complex and potentially repeat procedures like general anestesia, cystoscopy and dilatation may be more profitable for them compared to simple one-off solutions such as meatotomy.
Thank you all
Ben