Otis Urethrotomy? To have it? Not to have it for stricture?

Kidney and urinary tract
1

I have suffered bouts of cystitis since I was 16 (I’m now 32). More often the test results would show negative, but I would still be treated with antibiotics. I don’t think there is one antibiotic that I have never had. Approx 18 months ago – and whilst on an alternating prophylaxis treatment of one antibiotic per day I had an operation called a cystoscopy with urethral dilatation.

I have now been in chronic pain – urethral and supra-pubic from the date of this operation until now. I believe that the cystoscopy actually made my symptoms worse.

I went on holiday in October to the Caribbean and ended up in hospital with further pain which turned out to be a simple cystitis infection. £2,000 later this infection makes the urethral pain and suprapubic pain feel immense. I felt as though my whole body was on fire.

When I returned to England, my consultant put me straight away on an alpha-blocker and I was diagnosed with urethral stricture. Within 2 weeks – (to the day) the pain disappeared. I couldn’t believe it! Something that worked. Something other than ibuprofen and codeine.

I still take an anti biotic following intercourse for the low lying bacteria that my body does not resist, but the alpha blocker has been a god send.

My Urologist now wants to do an operation on my called an Otis Urethrotomy. I have heard mixed reports about this operations effects and indeed results. I have been told there is a risk that I may be left incontinent or have a life time of self catheterizing. Something which I don’t want to trade in – especially if the alpha blocker is working.

Does anyone have any comments on this? Also – Does anyone know – will the alpha blocker soon stop working? Will the stricture get any worse?

2

My own experience: disastrous failed urethrotomies, followed by urethroplasty three years ago which has been invaluable. I'm male. OK, so maybe this prejudices me against urethrotomy, but it's true that it's generally not curative, especially if you've already previous failed stricture treatment.

Is there some evidence that the stricture is in fact responsible for your symptoms? Is your stricture actually causing any significant obstruction, or can you actually void normally? If you don't have any serious obstruction, what exactly is the urethrotomy supposed to accomplish?

You believe the cystoscopy (or dilatation) made your symptoms worse. That could be, at least if the stricture is involved. Urethral instrumentation can cause and worsen stricture disease.

Don't know about alpha blockers, sorry.

Useful Reading:

Review – Reconstructive Urology

What is the Best Technique for Urethroplasty?

Daniela E. Andrich, Anthony R. Mundy *

Institute of Urology, University College, London, United Kingdom

Many, if not most, urologists believe that there is a \"reconstructive ladder\" and that treatment should always start at the bottom with dilatation and urethrotomy and work up the ladder to urethroplasty as a last resort. This is nonsense. Unless a patient has a single, previously untreated, short, membrane-like stricture of the bulbar urethra, in which case there is a 50% chance of a cure with dilatation or urethrotomy, the only predictable cure for a urethral stricture at present is a urethroplasty.

http://cirugiauretra.grupoaulamedica.com/pdf/bloque2/b2_46.pdf

Urethral stricture: Urethrotomy vs. definitive repair

Urethroplasty's high success rates make it the preferred choice over temporary measures

Publish date: Oct 1, 2002

By: Steven B. Brandes, MD

http://www.modernmedicine.com/modernmedicine/Hands+On/Urethral-stricture-Urethrotomy-vs-definitive-repai/ArticleStandard/Article/detail/34748

Repeat Urethrotomy and Dilation for Urethral Stricture Disease is neither Clinically Effective Nor Cost-Effective

http://www.urotoday.com/browse_categories/urologic_trauma_and_reconstruction/repeat_urethrotomy_and_dilation_for_urethral_stricture_disease_is_neither_clinically_effective_nor_costeffective.html

Urethral Strictures

Author: Richard A Santucci, MD, FACS, Chief of Urology, Detroit Receiving Hospital; Specialist-in-Chief of Urology, Detroit Medical Center; Chief of Urologic Trauma Surgery, Sinai Grace Hospital; Director, The Center for Urologic Reconstruction

http://emedicine.medscape.com/article/450903-overview

Urethral dilatation in women: urologists’ practice patterns in the UK

M MASARANI, RG WILLIS

Department of Urology, Royal Cornwall Hospital, Truro, Cornwall, UK

Ann R Coll Surg Engl 2006; 88: 496–498

Review of the literature reveals little evidence to prove the efficacy of urethral dilatation for adult women with various lower urinary tract complaints.

http://www.pubmedcentral.nih.gov/picrender.fcgi?tool=pmcentrez&artid=1964673&blobtype=pdf

3

I had an operation called a cystoscopy with urethral dilatation.

I believe that the cystoscopy actually made my symptoms worse.

When I returned to England, I was diagnosed with urethral stricture.

Will the stricture get any worse?

Strictures often do get progressively worse, so that could happen. If the stricture isn't at present causing any real problems itself (hard to say from here), you may consider 'watchful waiting' - just wait and see if it progresses and how fast.

Here's another article that could be of interest:

Technique Of Urethroplasty For Female Stricture Disease Described And Results Reported

In the past, it was common practice to perform urethral dilations on women who complained of lower urinary tract symptoms. There is no evidence to suggest that this intervention works and many cases of true urethral stricture are likely a result of these unnecessary dilations.

http://www.medicalnewstoday.com/articles/39663.php

4

Hollywood, would you mine shooting me your email to further discuss Otis Urethrotomy.  I have the operation and notied you mention the incontinent risk, I'd like to talk to you.  I wish I had known this also.