In order to test the effectiveness of urethroplasty surgery, urologists perform something called a voiding cystourethrogram (VCUG). This procedure (see my post – Catheter-Free After Test To Ensure The Urethroplasty Was Successful! – for more on that), if it shows that all is well, will end with the happy circumstance of removing the catheter from the patient. It’s a pretty big milestone in the ordeal of someone who has had a urethral stricture.
I want to report how things are exactly one week after my VCUG. It was a huge relief to have the catheter out after six months. And happily, the surgery worked so well that my, umm, flow-strength was unbelievably powerful. I actually cried out in alarm the first time I went to pee at home. My wife thought something had gone dreadfully wrong. But the opposite was true. I had to take a step back away from the toilet.
But even though the VCUG was 17 days after the surgery, I continued to have pain in the area of the incision – the perineum. I had to sit on an inflatable “donut” if I wasn’t lying down or standing. Unfortunately, as I write this 24 days after the surgery, the situation is the same as far as the pain and discomfort in that area.
Part of the problem is that the stitches, which I am assured are supposed to dissolve, are still very much there. And there are several little barbs protruding from the skin and causing some of the pain.
The other part of the problem is the that during the surgery, they retract the scrotum via some sort of strapping device (I’ll try to get more info on that), and that can cause quite a lot of trauma to the scrotum and its contents. I still seem to be feeling pain from swelling associated with that as well.
[Update on Aug 12, 2013: the stitch that I felt poking out seems to be gone. I guess the stitches have dissolved. Unfortunately, the pain has no changed. So there must not have been much, if any, irritation caused by that pokey stitch. Also, after doing a bit of research I found that the scrotum is retracted via a “retractor ring” very similar to the Scott Retractor, which you can see in the picture at the following link (it’s a bit graphic – just so you know): https://www.urology-textbook.com/perineal-surgery.html. After seeing the picture, I’m not very surprised that there is still pain down there. The retractor pulls pretty hard away from the perineum in order to help provide tension. And the scrotum is held and locked down pretty firmly in order to keep it out of the way. I’ll ask tomorrow (4 weeks after the surgery) if this pain is anything to worry about, and if it was likely caused by the retractor. And I’ll update you with the answer]. [Update on the answer on Aug 16th: I talked to my surgeon today and found out that though it is, in fact, normal to still feel swelling and discomfort in the area of the surgery, I was actually prolonging the pain in the scrotum area! Read about it here: Causes Of Scrotum And Testicle Pain Weeks After Urethroplasty.]
It may be several more weeks before either of these remaining issues resolve themselves. From what I have read, and from what my doctor said, it isn’t serious and will all heal up in time. Some guys heal quickly while others take as long as 3-4 months to fully heal.
So that is my status 1 week after VCUG and 24 days after the surgery. I’m writing this post as I sit on my donut in my recliner [note: in the Aug 16th update above, I learned that the donut-pillow (without anything to support the scrotum also) was prolonging my pain!]. I will continue to provide periodic updates until everything is healed.
Cheers,
Ken
Ken,
What are your next steps from here? I am interested to hear what you have been told by your doctor and what things you are hoping to do in preparation of being back to 100%+.
Hope you recovery is going well.
C
Hi Chris,
On Tuesday I’m going to call Urology and leave a note to let them know I’m still having pain and discomfort in those areas. I’ll let you know what they say. That’ll be 4 weeks from the surgery.
On the day they did the VCUG, I asked about the pain and they just said to let my body tell me when it’s ready to sit down normally and get back to normal activity. Nobody seemed to be concerned, though they did say that after 2 weeks they expected things to be better.
I’ll let you know what they say on Tuesday.
Right back at you on the recovery wishes!
Ken
I have to keep telling myself sometimes that it has only been a little over a month since the surgery and to go easy. I am nearing that 6 week post-surgery time that they say I can begin lifting a bit more than 10lbs and a few other things. I am hoping to get into a routine with free weights to regain some of what I lost. I just hope that I didn’t mess anything up along the way that will keep me from getting to the place where I was.
Today I was kind of achy and sore inside around the incision site. I did do about an hour of yard work too, that may not have helped it, but it sure felt great to be outside in the sun and fresh air.
ken,
I had a bad VCUG experience 21 days post urethroplasty surgery . I live in Dallas and had the surgery done on December 31 2014, so 21 days post surgery. The thing that made it bad was 2 things. One they saw a leak and so wanted me to spend another 14 days in a catheter. Secondly and here is where your experience helps, I had a lot of bleeding when they took the catheter out and I urinated. When I say a lot I mean it did not look like urine tended with blood it just looked like blood and seemed very thick. The radiology folks said that bleeding was normal but I was not prepared for what seemed like nothing but blood. How much blood did you have during the VCUG? My doctor was in other surgeries most of today and will be calling me on Thursday. The radiologist seems to think that the repaired stricture site, repair was in bulbar area, looked good but the leak was a little closer into the penis itself and was contained in the spungy area. The only thing I can think that would have caused this was removing the catheter . It Would help me if you explained how much blood was on your voiding test.
Thanks for your help,
Jeff
Jeff,
Thanks for the clarification. Here is what I THINK could have happened. But as always, I preface with a reminder that I am not a medical professional. If the repair was in the bulbar region, I assume you had an end-to-end with a perineal approach, correct? In other words, they didn’t operate directly on your penis? Also, can I also assume you had not been seeing a lot of blood in your drainage bag between the surgery and the VCUG? If all that is true, then it seems to me that the blood can only have come from 3 different places. Either it was in your bladder (perhaps from cath tip pokes or pinches), but didn’t come out into your bag because it was below the level of the balloon and outlet. Or it could have come from the area of the repair – possibly having built up around the outside of the catheter tube (where it couldn’t have come out into your bag). Perhaps the pressure of the tube against the inside of the urethra there kept it from leaking out of you around the outside of the tube “the normal way.” It also seems possible that blood from the repair site could have seeped down along the outside of the catheter and gotten trapped all along the urethra even down close to the penis, but stayed there trapped because of the cath tube. If it was from the surgery site, hopefully it wasn’t because of an incomplete repair or a tear in the repair. Lastly, it is possible, though I think unlikely, that it could have come from a new “scratch” or similar CAUSED by the catheter removal. The tubes are pretty flexible and slippery, so a new injury seems unlikely, but maybe possible.
So if your doc(s) aren’t thinking that the repair failed, I’d trust that, and assume for the time being that the blood was either just left over from the surgery or just from some bladder irritation caused by the catheter.
I hope that helps.
Ken
Ken,
Thanks that dose help and you are right those are all possibilities that could explain the blood. Still waiting to hear back from my surgeon today and yes my procedure was the same as yours . Hoping that after another 14 days in catheter will close the leak. I will keep everyone updated. Thanks for have such a great web site it has been a tremendous help.
Thanks,
Jeff
Just a quick update. The official findings from the VCOG were the following. 1. Voiding urethra appears patent. Extravasation/intravasation into the
corpus spongiosum with right groin venous intravasation. On February 2 I go in for another VCOG. Please keep me in your prayers that the leak will have healed closed. I will update again after the test.
Jeff
Sending healing thoughts your way, Jeff! Best of luck with the Feb 2nd test!!
Ken
Praise God I am catheter free. My second VCOG went well. All looked good with no leaks. My stream seems strong. I will not have a flow analysis for another 3 months. Still have a little bit of pain around the scrotom area but that is to be expected 33 days post surgery. I have been following Ken’s advice about the towel. The last few days I was having a lot of bladder spasms from the catheter so I was taking ditropan for that. I will need to retrain my bladder because I noticed that when you have to go its a very sudden and strong urge to pee. Thanks Ken for all your help and positive thoughts.
That’s awesome news, Jeff! So glad to hear it. Best of luck moving forward!
Cheers!
Ken
Ken,
Sorry to hear about your continued discomfort. I’m a little over a week, with only a slight tightness at the incision site and under the testicles. You can tell when they sutured how they had to pull it tight. I did have some numbness in my testicles from the clamping to hold them, but that has resolved. Stream is consistent, bladder feels empty. I have no sutures left and mouth is almost back to normal. You can barely see where the incision in the perineum was.
I am curious how long it takes others to pee, just to put my results in perspective. I typically take about 30 seconds or so, maybe 45-60 for an entire trip from start to finish.
Hi Josh,
My time is considerably shorter with the repair. I am about the same length of time, 30 seconds to empty. It really does feel great to feel emptied out.
C
Josh,
I have a HUGE incision where it is very visible. I can’t imagine it ever not being. Also the stitches are still there. there is an end still sticking out and a bit stiff. Plus there still seems to be some swelling in the scrotum.
But as for the pee, I empty in 10 seconds or less! That’s one of the amazing things. The stream is so strong and wide (area of cross-section, for lack of a better way to describe it), that it empties just that fast. So I guess I should be glad for small victories.
Ken
Hi Ken,
I am looking forward to hearing about the 6th week – yours and other guys.
It seems that the 6th week is the exit out of many of the last surgical/medical “watch areas” (lifting, intercourse, bending, etc).
For me, I am noticing that the incision is really finishing healing up – sutures dissolving and coming out, the incision itself starting to flatten out, inflammation under the incision going down, more comfort from the area.
I anticipate this next phase to be the hardest because I will have no reminders to not do something stupid. So I need to remind myself of where I was and where I need to go on a daily basis.
Hope all is well with recovery for everyone. I know for me it is hard to believe that this all happened only a short time ago.
All the best,
C
Thanks Chris. It’s awesome having you out in front of me, scouting the landscape:). I am still dealing with scrotal/testicle pain, and still can’t really sit on anything comfortably but my donut pillow. Yesterday was 4 weeks. I called and left a message for my doctor (the one who actually assisted in the surgery). They said he got the question and will call me back today. I’ll comment with whatever news I get.
I updated the above post on the 12th with info on retractor devices for the scrotum during perineal approach surgery. One of the pictures on that link shows how the Scott retractor holds, and stretches the scrotum during surgery. It isn’t a leap from there to help understand the trauma.
Other than that, though, stream is still super strong most times. Occasionally it takes a few seconds to build from what I used to call normal to the super-human flow received in the up-grade;).
Thanks again!
Ken
Yes, my stream is sometimes like that too.
Any post-void dribble issues? Mine seems to be working itself out, slowly.
Another thing that I noticed tonight is the swelling under the incision. I have felt it there before and brought it up to my doc at the VCUG test. He said it should go down. It seems to be a little different today, more bulb-like at the front. Doesn’t cause pain to touch and it feels quite firm, like muscle.
Just wondered if anyone else has noticed this under the incision?
Chris,
I actually felt something like that early on – like a week after. It felt like muscle or tendon. But it was more rope-like than bulb-like. And it didn’t hurt when I touched it. I mentioned that to my surgeon at the VCUG and all he did was say, “huh – must’ve been from the retraction.” That was it. And it went down within another week.
I still do feel swelling under the incision, sort of like … not to be gross, but to be descriptive … there is something up my butt. That has been pretty consistent, though. And seems slowly to be going down. Hard to tell. I’m testing the whole sitting-without-the-donut thing every couple of days and have yet to feel like I could, due to the swelling underneath.
Ken
Tomorrow is four weeks for me. I still have a nice consistent stream, not super-human like Ken, but I’m emptying nicely. As I write this, I just realized I haven’t peed in almost 4 hours, and don’t even have the urge. That’s with drinking water and a beer. I do have some soreness at the incision site still, and can’t sit leaning forward yet, but I’m feeling great overall. I went for my first walk around the block tonight, and it went good.
Ken, I hope your discomfort resolves soon. I find it odd that it stills bothers you that much.
Thanks for the comment, Josh. So we are only 3 days apart. I went for my first long walk yesterday with no wind problems. I did have some scrotal pain along the way, but nothing terrible. This morning, I felt like I back-slid a couple days on the pain though, probably because of the walk. Different people heal at different rates, so I’m hoping that is what this is. Oh, and I also discovered that I do still have a stitch sticking out down there that is a bit scratchy/pokey. That may be contributing to stuff too.
I still await my return phone call from my urologist. I left a message on Tuesday (the 4-week point) asking about the scrotal pain.
And just like you, Josh, I’m in that place where it’s the leaning forward that hurts when sitting. I tried sitting on a regular chair for a little while last night, and definitely had to lean back to do it. So I feel like it should only be another week or two before I’ll be able to sit normally without my donut pillow.
Anyway, thanks again for the update, Josh!
Ken
Just wanted to update that I’m now after the DVIU (after the failed urethroplasty) about 2 days after the catheter is out. The flow is heavenly and it feels great. The flow is very very strong and it feels great. I just hope this will last, and very afraid it won’t. In retrospect seen this flow now I understand that I had a stricture recurrence almost immediately after the urethroplasty… I really hope it will work and really afraid my flow rate will decrease with time… My current stricture was a bulbar stricture of about 7mm in the end-to-end connection of the urethroplasty (before I had a 1.5mm stricture). So this does have a chance of working, but also a good chance it will decline with time… anyway it is really great to pee currently the flow is just so strong this is how I peed 10 years ago and I have forgotten completely the feeling.
Hi Eli,
Great to hear that all is flowing well. I had those same feelings of waiting for the flow to decrease only to be pleasantly happy when it doesn’t.
I hope that you find the same results with every waking day!
It is great isn’t it? Feels like being a “normal guy” once again.
All the best.
Hi Chris,
It is absolutely fantastic. I haven’t peed like this since I was 15 probable (I’m now 30). I forgotten how it feels like. I now have often this good feeling which comes when your bladder completely contracts which is really really cool.
I’ve done Uroflometry yesterday. I had a Qmax of 21 and Qaverage of 15, this is compared to 10 max and 5 average in the 10 years before the urethroplasty and DVIU, so this is a huge improvement and is almost normal flow.
I now just really hope these results will last, because in DVIU there is a significant chance of stricture recurrence. If this holds for 6 month then its very probable it holds, so I now have to wait about 6 month to see if this holds. So I hope my case will be like yours and I’ll just wait for the flow to decrease but it will never come 🙂
That’s awesome Eli! Good luck going forward!
Ken
Good news Eli! I hope your DVIU lasts. For folks who don’t know what a DVIU (direct visual internal urethrotomy) is, see my post here: https://livingwithacatheter.com/dviu-treatment-for-urethral-stricture/ Most of the literature has stated that urethrotomies have only between a 30% to 50% long-term success rate. Though I just found a 2013 article which states “DVIU is best utilized for short strictures less than 1.5 cm that involve the bulbar or pendulous urethra. DVIU has a long term success rate of 74% if the above criteria are met.” The source for that article is here: https://www.amepc.org/tau/article/view/1251/2429
So Eli, though it is still agreed that urethroplasty is still the gold standard when it comes to long-term success rates, there are obviously some folks, like you, for whom the urethroplasty was not successful. And since it looks like urethrotomies are known now to have up to a 74% success rate, that’s good news for you.
Good luck, and let us know how you get on, if you wouldn’t mind.
Thanks again!
Ken
Hi Ken,
Thank you for the article. I have also read several other scientific articles which show there is a decent chance of long term success with DVIU when its 1. Bulbar stricture 2. shorter than 10mm 3. minimum spongenous. Mine was 7-8mm in the bulbar area, but a bit spongenous. So this has a reasonable chance of success.
My main conflict now is weather to self catherize once or twice a week for a year with a 16 or 18 FR hydrofilic catheter (like Coloplast). I have read many many scientific articles which show that self catherize just one or twice a week with a 16/18 FR catheter dramatically increase chances of DVIU success. This is a piece of cake for me as I have catherized myself as often as 12 times a day at times. My conflict is because my urologist claims that there is no such evidence and that it may only hurt my urethra and increase chances of stricture recurrence, but every scientific article claims the contrary. I am tending towards doing self cath now once a week for a year. Since I’ll use hydrofilic catheter friction will be minimal, so most likely it can only help if research is correct.
If this interests you you can look at these researches which support once a week self cath after DVIU-
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3193742/#ref34
https://www.ncbi.nlm.nih.gov/pubmed/19353382
https://www.ncbi.nlm.nih.gov/pubmed/1635124
https://www.ncbi.nlm.nih.gov/pubmed/8460455
And again thanks for the comment and I will let you know how my situation progress, and if flow indeed remains as strong 6 month and 1 year from now..
That’s terrific, Eli! And thanks for the links. It seems like the evidence (ACTUAL evidence) is there to support what you’re saying. Knowledge is power. It would seem to me (who is not a medical professional – a reminder for those who haven’t been to the site before;)), that with your ton of experience self-catheterizing, you would be more likely to be able to do it without damaging your urethra.
Thanks again for providing us the data and your story. And good luck! We look forward to hearing how things work out for you.
Cheers,
Ken
Hey Guys – just wanted to let you know about my VERY informative conversation with my surgeon today about the on-going pain in the scrotal/testicle area. The latest post – https://livingwithacatheter.com/causes-of-scrotum-and-testicle-pain-weeks-after-urethroplasty/ – goes into detail. But the 2 main take-aways were these. 1. IT is normal to still be feeling swelling and discomfort around the area (including scrotum and testicles) at this point (4-5 weeks post surgery). He also said that by sitting on my donut-pillow all the time, I was actually prolonging the pain in the scrotum/testicles! This is because by doing that, I was allowing the scrotum to hang, mostly unsupported, in the donut-hole. He said I should be doing the opposite by putting, say, a rolled up towel under the scrotum. By allowing all that to hang loose, it was increasing the inflammation.
Anyway, needless to say, I’m sitting here now with a towel under my sack;). I hope this helps. It should help me. I’ll know more definitely in a few days.
Hooray for knowledge!
Ken
Just wanted to let you know that I just set up a forum on the site! It might make it easier for all of us to keep up with each other rather than having to use the comments sections across multiple posts. Right now I have a “General Discussion” forum and a “Urethral Strictures And Their Treatments” forum. You can find the forums page here: https://livingwithacatheter.com/community-forums/
I’ll be putting this comment on multiple posts so everyone who has been involved in our discussions is aware, so I apologize in advance for the possible duplicate e-mails you may get.
Cheers!
Ken