Urethrotomy , can it be successful?

Kidney and urinary tract
1

I have always had a week urine stream, though I have never had to strain, it takes me about 20-30 seconds to urinate.

I get up once or twice every night to use the bathroom. There is always a little dribling afterwards. This is not affected my life much though it is irritating to be only 28 and not have a 'normal' flow rate.

Last year I developed very intense pain on urinating and bleeding. I felt as though I was peeing acid. Eventualy after 5 trips to the GP I was diagnosed with infection and prostitisis. One month of powerful antibiotics and I was back to normal.

On getting refered to a Urologist they did the flow rate test, Scan, Xray, Cystoscopy flexi (not painfull in my experience) and urethrogram (painfull but bearable). I has diagnosed with a urethral stricture and a flow rate of 10ml per sec.

The Urethal stricture is quite bad and blocks 75% of the uretha, though it is not long. It is situated at the base of the penis.

Because of this the Consultant said it would be silly to ignore it, it could lead to problems later on in life.

I feel that urethroplasty is too drastic so agreed to have Urethrotomy. I will be having it over the next few months. I am VERY anxious about the op. Though it is minor it feels like a big deal to me.

Does anyone have any good experiences of Urethrotomy working long term???? I have tried to find some positive experiences but am yet to many????

I can't help but think what is the point? My condition has little or no impact on my life apart from going to the loo at night? Any possitive experience to justify the procedure?

Thanks for reading and sorry about any dodgy spelling!

2

Okay. NOBODY answered me, but I went for the urethrotomy anyway.

repetedly told it only had a 50% success rate, but it is worth trying before urethoplasty. Also the Dr performing the procedure is (i am told by the staff in two hospitals) the most respected urologist in the country. It would have been silly for me not to take the op.

The procedure was only 20min. Once I was out from the genral there was only a little pain, but the catheter experience was not nice at all.

I had the Catheter removed the next morning (Painfull but totaly bearable). Straight away I was peeing twice as fast as I have ever done in my life. The dr said it had opened up nicely and it had been a stricture of 1.5cm.

Now just to hope it does not come back. I am going to learn how to self cathetherise next week, then cyto in two months.

Just to hope and pray it works. For now, I an very happy with the op, but it was just two days ago.

3

Okay. NOBODY answered me, but I went for the urethrotomy anyway.

Yeah, I think the amount of traffic on here isn't that high, so chances aren't very good of your message being seen at the right moment by someone who would have an opinion.

It's good that they did tell you about the low cure rate with urethrotomy and discussed the possibility of urethroplasty (with its higher cure rate). You've been better informed than a lot of people.

If you do get recurrence - I hope not - then cure with urethrotomy is very unlikely.

How to Pass the FRCS(Urol)

Q. Describe, in general terms, how you would manage an anterior urethral stricture:

Avoid the so-called ‘reconstructive ladder’ where several urethral dilatations are followed by several optical Urethrotomies and eventually definitive surgery in the form of an Urethroplasty. This sequential process may extend the length and depth of the stricture increasing the complexity and compromising the outcome of Urethroplasty.

Aims of treatment of urethral stricture disease – firstly define the goal of treatment, which essentially is whether the patient wishes his/her stricture to be managed (periodic dilatations or Urethrotomies) or cured (by Urethroplasty).

http://depts.washington.edu/uroweb/print/pdf/urologyNews_howto_06.pdf

4

diagnosed with a urethral stricture and a flow rate of 10ml per sec.

The stricture is quite bad and blocks 75% of the uretha, though it is not long. It is situated at the base of the penis.

Because of this the Consultant said it would be silly to ignore it, it could lead to problems later on in life.

My condition has little or no impact on my life apart from going to the loo at night

repetedly told it only had a 50% success rate, but it is worth trying before urethoplasty

It's a matter of opinion whether or not urethrotomy is worth trying before urethroplasty. Most importantly, it's a matter of your opinion as a patient. If you feel you can't form an opinion, perhaps your doctor hasn't given you all the information you would need to make an informed decision.

If the stricture is implicated in the infection you had, that might justify surgery. But from what you say, it's unclear whether the stricture has contributed to that. I think it may be a matter of speculation as to whether it did or not.

The popularly-quoted 50% success rate with urethrotomy isn't a blanket figure. That's if you carefully select just the best strictures - short, flimsy, previously untreated, single strictures, located in the bulbar urethra.

I take exception to the suggestion that not doing a urethrotomy constitutes ignoring the issue. Has your doctor never heard of 'watchful waiting'? It is not \"silly\".

You say you've always had a weak stream - not that it has been getting worse. You've had an infection - what, once in 26 years? And it was fixed with a course of antibiotics. My feeling is that isn't a bad record. It sounds like the stricture has always been stable and not given much trouble.

\"... little or no impact on my life apart from going to the loo at night\". (That's something I'd never experienced, until after a urethrotomy on my asymptomatic stricture produced a stricture that was far from asymptomatic.)

My view would be that that's quite a problem, and I'd probably have it treated if the treatment gave a good chance of fixing it.

You don't say whether you had complete voiding or had a large residual volume after urination, or whether your doctor reckoned the surgery would help with that, or whether it actually did once you'd had it. It'd be interesting to know.

In my own case, urethroplasty has helped quite a lot with having to get up at night, after the urethrotomy left me with that problem. But I've never regained the bladder capacity I had to begin with.

\"There is always a little dribbling afterwards\". I never had that problem, till the urethrotomy gave me it. I've had to live with it ever since.

You don't mention catheterization in your posting before the surgery, but you do afterwards. Do you mean they didn't tell you about that?

Intermittent self-catheterization is predicated on the urethrotomy not having cured the stricture. It's supposed to slow down recurrence but it's not going to cure the stricture either.

To sum up my own personal opinion:

So there's said to be 75% occlusion. So what? If you're urinating without straining, have a 10 ml/s flow rate, if you're voiding completely (seems doubtful, but it's not really clear from what you say), if it hasn't been getting worse, and if you've only had a urinary infection once in 26 years, then I have to wonder where's the benefit that could justify the surgical risk.

Urethral Strictures, Male

Author: Angelo E Gousse, MD, Professor of Urology and Gynecology, Director of Urology Residency Program, University of Miami, Miller School of Medicine; Director of Voiding Dysfunction, Reconstruction Fellowship

Surgical treatment of urethral stricture disease is indicated when the patient has

5

You had the catheter removed the next morning? Mine will be in at least a week to prevent infection during the healing process, according to my urologist.  

6

I was misdiagnois with urethral stricture for bladder outlet obstruction.  The doctor misdiagnois me and performed the wrong procedure.....urethral stricture surgery Internal Urethrotomy.  Immediately following surgery the misdiagnois and wrong procedure caused me to be permanetly totally incontinent.  I had four surgeries after to try to correct his error.  I now permantely self catherize, suffer with many urinary tract infections which I never had before the surgery.  My complaint before the surgery was that I got up a lot to go to the bathroom. I had an Overactive bladder.  The urodynamics I found out after his misdiagnois never ever showed urethral stricture.  All tests, ultra, showed no stricture.  The doctor also lied and said he told me repeadetly that I could be incontinent.  Ladies, I learned the hard way.. we have to trust God, knowledge and research and talk to each other. I feel even with research it is not even women we have to talk to each and tell each other our experiences to help others.  The doctors are misdiagnoising us and botching our bladders and then covering it up with "judgment calls.  Please respond to me I am in the process of making a difference for women like us.  It is a FACT that most women who are suffering who were told that they have urethral stricture is not so. Please this is not just because of what happen to me this statement is true because certain physicians have told me so.

 

7

I was misdiagnois with urethral stricture after the surgery Internal Urethrotomy I became totally incontinent. I had four surgeries to try to correct this misdiagnois and wrong procedure.  I eventually had to have reconstructive surgery.  I now self catherize for the rest of my life.  Unfortunately for me my doctor lied and gave me incorrect information.  It was later discovered that there was No Test that showed any urethral stricture.  There was no imaging/Rays, that showed any stricture.  I had an overactive bladder and I found out that if your doctor is treating a lot of men he will read the tests for men the same way for women causing misdiagnois.  It's more to this and I'm drained because doctors are being allowed to cover up the erroneous errors.  I just like to say to all just like medexperience take your time and just don't trust all doctors, do your research, homework.  I wish I knew more.  I am now actually helping women like myself because I was force to learn about the whole conversation of urethral stricture, the testings in the difference between women and men, and how rare it is among us ladies.  God Bless and medexperience, thank you for your discussion.

 

8

Sorry for this late reply. I would like to share my experience with Urethral Stricture.

I am now 70 years old and was diagnosed with Urethral Stricture when I was 25. I don't know how I contracted it. Best guess is that I was hit in the groin when playing cricket!

I had the first Urethrotomy when I was 25 and have had regular urethrotomy (starting with once a month and graduating to once a year).

About ten years ago I had a sudden total cessation of flow which resulted in surgery to cut into my bladder. Following a follow up urethrotomy, I was persuaded to perform self catheterisation. I was reluctant to start with but have avoided any form of urethrotomy for the last 10 years.

Unfortunately, I have had a nother total cessation but am able to make do with the smallest of the single use catheter. Soon I expect to have my first urethrotomy in ten Years.

I hope to able to avoid urethroplasty.

Hope this helps.

9

My 26 year old special needs son has had several urethrotomys after a botched catheter for hernias. Usually a couple of days after each he has been fine for 3 months before needing it done again. This last time it has been 5 weeks and is still having a lot of penis and lower stomach pain. He also has now started wetting his pants during the day. Next procedure is a uroplasty but l dont know how he will cope with this one. Cant let him be in so much pain though.

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Sorry l meant urethroplasty.

11

I'm male, age 57. It's interesting to read your comments, David, abotu single-use catheters preventing recurrence. I have to intermittently self-catheterise, three times a day, because quite suddenly I couldn't urinate at all. The cause is as yet unknown, but my urethra is so narrow that they can't get the cystoscope in to find out! And it's getting narrower, harder every day it seems to get the catheter past the exterior and interior sphincters - so regular catheterisation isn't preventing my stricture (if that's what it is). The consultant has put me on a list for urethrotomy, but that seems hasty when the cause of my failure to urinate hasn't even been diagnosed yet. But then again, I suppose they may have to perform a urethrotomy to get the camera in to make a diagnosis. Is there any way of examining the state of the urethra and bladder without a cystoscopy?

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I'm curious about your son's botched catheter. What was botched about it? I think I may have a stricture caused, or at least made much worse, by the really violent insertion of a foley catheter into my penis when I was admitted to hospital with sudden failure to urinate. Most painful thing I've ever experienced!

I'm sorry about your son's experiences. On another strand here patients were reporting that self-dilation greatly helped increase the time between recurrences of their strictures. I know your son has special needs - would self-dilation be an option for him?

13

My son had bilateral inguinal hernias repaired and when they put the catheter in they caused damage to the urethea which has caused scaring and stricturing. Being special needs it is hard enough to clean it there is no way he would let me put a catheter up there every few days. Hence the 3 monthly trips to hospital the unblock it. Next step is the big op to fix it permanently which l am not looking forward to. He had it unblocked 5 weeks ago but has pain when urinating now , pain when his bladder is full and the odd accident of wetting himself because he cant hold it. This hasnt happened the other times he has been done. He cant win at the moment has that, really bad reflux as well as pains in his bowel. Not a happy chappy.

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Thanks for your speedy reply. Only five weeks, that's not so good. Poor chap, and poor you. Hope you both get some longer lasting relief from all this soon.

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I hope for my sons sake we do. He is starting to get get a bit fed up with all the pain. Thanks Colin. I certainly would certainly hate to be a man with these problems.

16

I had this procedure done recently and they left the catheter in from Thursday and removed Monday with instructions to self cath once daily using a steroid creme on the cath.

17

To diagnose my stricture, the Dr used a dye inserted with a syringe into the urethra from the end of my penis and took xrays.  The strictures showed up on the xray, you could see the narrowing because the liquid showed up as dark on the xray.  It was a quick procedure that they did with no anesthesia or anything.

18

I just had a urethroplasty last week. The pain is standard surgical pain, the surgery isn't the guage, it's an individuals personal High pain threshold or low pain threshold that matters. If he's had that much medical involment in the past I '' confident that he's developed good ways to mentally manage pain.

My only irritation with the surgery was the Buccal graft (donor material) from inside the cheek.

19

HI.  I am the OP back after a 7 years.  I stumpled over this old thread and have only just read the posts from the past few years and hope you are all doing okay regarding your strictures. 

Just a personal update....

After the Urethrotomy I went on to self cathetrise weekly then monthly for 3 years before stoping (I should have continued but as time went by just forgot),  As yet the stricture has not come back.  Though I am hoping I am not tempting fate by wrtiing this!

The Urethrotomy worked for me (for now), flow is good and no infections since the op all those years ago.  If you are having a Urethrotomy please please please catheterise religiously, I really think it is the main reason the procedure worked for me.

Take care

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Karen,  how is your son?