I have been catheter-free for 2 hours, the longest I’ve been without one since my ordeal with a urethral stricture began on February 8th, 2013. And it feels awesome!
As I mentioned in the post – My Urethroplasty Is Done! – I was scheduled to have a VCUG (voiding cystourethrogram (VCUG) today, which was 2 and a half weeks after my urethroplasty surgery. The VCUG tests whether the surgery was successful by filling your bladder – through the catheter – with contrast fluid, then removing the bladder and watching, under an x-ray, while you pee. If they like what they see (no restrictions in the flow and no signs of leakage), they let you leave without a catheter. And that is exactly what happened this morning:).
I was pretty nervous, worrying about pain and the possibility that things hadn’t healed yet, and I’d have to have the catheter put back in. The doctor said there was an 80 percent chance that things would work for the best. So there was a 1-in-5 chance things would NOT work out. That’s me. Mr. Positive.
Was It Unpleasant?
I expected that it might be painful. I didn’t know what if would feel like to have the catheter removed in that way (I was knocked out in surgery when they inserted this last one. And during the previous 6 months, ( had a suprapubic catheter). It felt momentarily uncomfortable, for like 1 second. And trust me, when I say “uncomfortable,” I mean it didn’t rise to the level of “painful.” That is how much of a pain-weeny (phrasing) I am.
Everything else – the filling of my bladder, then the peeing – was totally painless.
What Did They Do?
So here are the steps of my VCUG? For this office procedure:
- I got into a hospital gown.
- I got up onto the exam table, which was underneath an x-ray machine.
- They positioned me so that I was half lying down, and half on my side, in order to have the right angle for the x-ray video.
- They disconnected the valve (should have been a bag*) from the end of the catheter.
- They put a large syringe, from which the plunger had been removed, into the end of the catheter.
- They held syringe and catheter up about 6 inches above my body and started pouring the contrast fluid into it.
- They told me to notify them both when I started to feel the urge to pee, and then when I really had to go.
- After the last of the fluid went into my bladder, they told me to hold in the pee as they removed the Foley catheter. As soon as it was out, they held a plastic urinal while I peed the fluid out.
- The doctor watched the screen to make sure the urethra repair site was sound, and that flow was good.
- He said everything looked great, and that I no longer needed the catheter!
I have another follow-up appointment in 2 months, at which time they will do a flow-rate test. I’ll likely have periodic flow-rate checks for years to come, just to make sure I stay free of strictures.
I still have some healing to do from the surgery. My bottom is still too tender to sit down on regular chairs without my inflatable donut ring. I was told to continue to use soft pillows and/or the donut as I needed, until I could tolerate sitting without it. Also, I still have some pain in the scrotum from the surgery. That doesn’t happen to everyone, apparently. But it is not uncommon. They have to retract your scrotum (and contents, obviously) and hold it out of place for a few hours during a urethroplasty with a perineal approach. The remaining swelling and pain is from that. It will go away in another week or two.
That’s about it! I was not told to refrain from sex, but I will anyway, for a few weeks. One of the readers of this site was about a week ahead of me with his surgery/VCUG, and was told to refrain for 2-3 weeks. So that advice also seems to be variable from doctor to doctor.
As I write this, I’m getting the urge to pee, and it thrills me that I get to do it “the normal way!” I’ll continue to provide updates.
[First update. I went to the bathroom after writing this and my wife got concerned because I shouted “holy shit!” The reason I made such an exclamation was that the stream WAS SO STRONG. I actually had to step back about a foot further from the urinal. The was no pain for the first time in – well, I really can’t remember. And there was no dribble or need to shake, or need to squeeze out more when I was done! Sorry for the graphic nature of that explanation, but I had to describe it because it was AWESOME!]
* I mentioned that I SHOULD have had a bag (leg bag or bedside drainage bag) connected to my catheter. Why? Well, even though I was told by OTHER doctors that I could wear a valve instead of a bag (see my article – Using A Catheter Valve Instead Of A Leg Bag), that was ONLY after my 3 months of bladder rest (needed before the docs could get a truly accurate picture of the location and size of the stricture). But today, my doctor (the surgeon who actually performed my urethroplasty) said I absolutely should NOT have been wearing the valve AFTER the surgery! The reason is that allowing the bladder to fill puts pressure on the urethra, even if the balloon of a Foley catheter is blocking the way. If any urine gets into the urethra around the catheter before the repair has healed, it could easily wreck the repair! Fortunately for me, I kept using the bag for the first 10 days or so after the surgery. I didn’t switch back to the valve until the repair had healed. Also, I did not get any urine coming out from around the catheter (out the tip of the penis). So I dodged a bullet there! So here is the take-away for anyone about to undergo urethroplasty. DO NOT use a valve on your catheter. Just keep using the bag(s).
Ken, that’s great news. I’m so happy everything worked out for you. I think you’ll be all set from here.
I’ve got to ask a personal question. Since this whole ordeal started have you had to refrain from having sex? I’m just trying to learn all I can if I find myself needing this procedure.
Ken Theriot says
Since I had a suprapubic catheter, there was no prohibition against sex until after the surgery. I won’t say any more than that:).
Thank you. I’m sorry if I was too personal. Just trying to learn as much as I can. Now that you’re fixed you should go get a coconut water. Those will really give you a good stream.
YAY!! Great news Ken! I am so happy for you.
Isn’t it great to pee like a firehose?
All the best for the next phase of recovery. It is much easier than what you have been through so far.
Woke up this morning with a little blood in my urine. Not much to make it scary or anything but there was some when there hasn’t been before. Wondering if anyone has had the same or has been told by a doc if that would happen. Mine did not say.
Also, is the intercourse prohibition prescribed by some doctors because of the repair or is it because of the incision in the perineum?
Hope you “tube-freers” are doing well today.
and….not sure if it is me being hypersensitive but my stream seems a little slower than it has the past few days. Will have to see if I improves through the day.
I’m sorry to hear that. Maybe it’s just part of the healing process.
All good. Yesterday was fine through the day. I think I just overdid the day/night before a little.
No more blood this morning. Keeping the H2O going.
Hope Ken and Josh are improving everyday.
All the best,
Ken Theriot says
Chris, was your stream back to it’s strong post-VCUG glory? I have had a few slow-ish starts. I continue to be pretty amazed. I just went a few minutes ago and came out shaking my head again at how strong the stream is.
Also, because you said you were advised to refrain from sex for another few weeks, I’m doing that too. I plan to wait until all the scrotum and perineum pain goes away. It’s still pretty significant.
Ken Theriot says
I am sorry to hear that. I had blood through my catheter several times during the first week after surgery. But that was coming from the bladder, not the urethra. Foley catheters do quite a lot of damage to bladders. But 2 days post-tube-removal, everything has been great here in the pee department. I still can’t believe how strong the stream is. I don’t remember ever having it be that strong. But I’m still having a lot of pain in the perineum from the surgery. I still cannot sit on normal chairs. I have to use my inflatable donut ring. and my scrotum is still quite painful. My doc said it isn’t too common, but was probably from the retraction of the scrotum during surgery, which is what several others have reported over at the medhelp urology board – https://www.medhelp.org/posts/Urology/Recently-had-a-Urethroplasty-done/show/1680722
My doc didn’t seem too worried about it. And I’ve seen posts from others saying that it can take a month or two for all the swelling and pain from surgery to go away.
Good luck! I hope that blood was from your bladder and not your urethra. I think it’s worth asking your doctor.
All seems better. Have not seen any more blood, thankfully. I was going to call the doc if I saw more coming out. I too had the blood from the tip where the cath went in, from the surgery I was told too.
As for the intercourse part, my doctor said that the repair in still healing, that is why I suspect he is saying wait for about a month or so. I would rather hold off for a few weeks rather than do any damage to what has been done. I think we are playing it smart, Ken.
My stream is sometimes slow too. Which makes me say, “Oh man, it was too good to be true.” Then, I go again and WHAM back to the way it was post VCUG. One of the residents that came into my recovery room said that there really should be any slowing after the repair heals at all. YAY! I agree, I believe that my stream is better than it was before my stricture. Wow! I got an upgrade!! hahahah
All the best Ken,
That should read “The resident came in and said that there SHOULDN’T be any slowing after the repair heals.”
Whoa. Sorry for the scare.
Should proof read my posts better.
Ken Theriot says
I was confident that is what you meant;). No worries. Yeah, I feel like the bionic man – definitely “better than I was” even before the stricture. I just can’t think of any good use for the super power though:).
Good to hear about the improvement.
Putting out small evil fires everywhere? Hmmm….may need more beer.
Just to chime in on the intercourse part as well, my dr said “if I’m having you pee through it, sex isn’t an issue”. Ejaculation isn’t the thing that’s going to mess you up. Obviously, if it’s uncomfortable, don’t do it.
That is my thought on that too. I wonder why they have some people hold off then?
Maybe it is pressure on the incision?
Just doing some research on this because I wanted to see what the possible reason is for the difference with doctor recommendations.
** I am not a doctor, so this is personal research that I have done on my own.
Excerpt from Wikipedia:
When a man has achieved a sufficient level of stimulation, ejaculation begins. At that point, under the control of the sympathetic nervous system, semen containing sperm is produced (emission). The semen is ejected through the urethra with rhythmic contractions. These rhythmic contractions are part of the male orgasm. They are generated by the bulbospongiosus muscle* under the control of a spinal reflex at the level of the spinal nerves S2-4 via the pudendal nerve.
* Bulbospongiosus (bulbocavernosus in older texts) is one of the superficial muscles of the perineum.
In males it contributes to erection, ejaculation, and the feelings of orgasm.
This muscle serves to empty the canal of the urethra, after the bladder has expelled its contents; during the greater part of the act of micturition its fibers are relaxed, and it only comes into action at the end of the process.
From this I gather that the muscle that the doctor had to go through to get to the problem spot is the same one that is used for the ejaculation process. And, that the pressure from the build up of the semen from the ejaculatory duct could be quite intense in the urethra.
Again, this is my non-professional opinion of why some doctors are holding off on intercourse until the repair is well healed.
Ken Theriot says
Thanks for that, Chris! That is really interesting. Not sure how comfortable any of us would be reporting the results of our first efforts at ejaculation post-surgery. But it might be good to know. Maybe we could do it via e-mail. I know I’m curious.
I’m 24 hours tube free. I’ve had no bleeding or irritation when peeling and my stream has improved. I’m a little sore at the incision site from being more active. I also have no restrictions, whatever I’m comfortable with.
Did they have you wearing a suprapubic catheter for 3 months prior to the surgery, as well. Can you describe all the diagnostic procedures Dr. Santucci did leading up to your surgery?
No. I went to the urologist after two urethrotomies over the last 15 years failed to correct the problem. He referred me to dr. Santucci immediately to get it fixed once and for all. I was on the table within 60 days. The need for a suprapubic is normally due to complete urine retention. With your history, it’s possible, but I wouldn’t assume so.
The only other tests I has we’re a flow test, not painful, and an RUG, which was a little painful, but no biggie.
Ray Worthen says
I’m very envious you have it over with. I had an internal urethrostomy 18 months ago in the hope that a simple procedure would succeed but it eventually closed back down again as most do. I know about the fire hose phenomena though, for awhile I could empty my bladder in 3 seconds flat. It was alarming.
I’m scheduled for the urethroplasty surgery in October. I can’t thank you enough for this website. If it were not for this I don’t think I would have had to courage to get this thing fixed.
Hope your pain clears up soon as well.
Something to note. I’ve found the firehouse effect to be quite different between urethrotomy and urethroplasty. When I had my urethrotomies (2 of them), the size catheter they used was HUGE. When they took it out, it almost painful to empty my bladder and it was very fast. It also slowed down within a day or so.
With the urethroplasty, I didn’t have that same effect, but catheter they used was much smaller (and more comfortable). I now have a more consistent stream, and I feel empty and it’s now a few days in.
Ken Theriot says
Thanks for that info, Josh! It doesn’t surprise me that the urethrotomy (if folks don’t know what that is, see my post – DVIU Treatment For Urethral Stricture – It’s basically just slicing off the scar tissue that causes a stricture) would result in a slow-down after a few days, since the scar tissue that caused the stricture in the first place is still there in your urethra, just “cut-down to size.” The reason they have a low success rate is that the scar tissue tends to grow back. It is curious, though, that after urethroplasty, you wouldn’t have had that “fire-hose” effect that Chris and I are describing. What type of urethroplasty did you have again?
Either way, it’s good that you have a consistent stream now and are able to empty your bladder.
I had a bulbar urethroplasty with buccal graft. Don’t get me wrong, my stream is strong, just not as strong as I was expecting. But, my expectations may have been too high. I’ll find out if I’m “normal” in a few months at my follow up.
Ken Theriot says
Ah. OK, thanks for the clarification! Good luck on the flow test. Study hard;).
Ken Theriot says
Thanks for the vote of confidence on the site Ray! I’m so happy to know that it is helping folks:). We’ll be waiting to hear how your urethroplasty goes in October.
Ken Theriot says
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.
I am sandy,I met with an accident 10 months ago and got PFUDD (PELVIS FRACTURE URETHERAL DISTRACTION DISPLACEMENT), since then I was on SPC.
I got end to end urethroplasty on 05.08.2015(arnd 10 days before).everything is going fine .I have one SPC now and one PUC (catheter thru penis).
Yesternight I had nightfall kind of feeling and some drops of liquid (dont know whether urine or sperm) came out thru penis (though I have a catheter in it) and when I woke up in morning I saw blood in my urine(in the catheter which is in my penis). This happened to me second time.
Is there any issue of worry or I shud go to my doctor for this??
My urologist is planning to take the catheters out on 31.08.2015.
Ken Theriot says
First of all, if you ever have a concern you should definitely call the doctor’s office and at least ask. I did that ALL THE TIME – leaving messages, talking to nurses and doctors just to get reassurance on things. As for finding blood in your bag, that actually does happen sometimes though, even when nothing is really wrong. Sometimes the tip of the catheter irritates the lining of the bladder and causes a little bleeding. As for something coming out around the catheter tube, that is something you should definitely ask about. I never had that, though I only had the catheter through the penis for 10 days. I hope that helps!
Did you notice any change in penis size after the surgery?
Ken Theriot says
I don’t think so. Sounds funny to say, maybe:). But I never really “measured” before the surgery, and if there was any difference, I did not notice it. So I would have to say no. I hope that helps.
Has anyone had an orange kinda stain running down the catheter tube? I have had it for about 9 days now.
9 days with catheter not the orange stain lol
I just got my urethroplasty done about a week ago, I will go to see my doctor next week. What has me concerned is that I can void through the new hole but if I want to fully empty my bladder I have to use my suprapubic catheter which releases a higher amount. Its been like this for the past couple days and before I left the hospital I showed my doctor and he said there was no issue and I would be fine. But its been a couple days later and I am worried, I just tried voiding and putting a finger over the hole where my suprapubic catheter comes out and clamp off the catheter and the stream seemed stronger but still not able to fully empty. Any advice or suggestions? maybe I will be fine once they take the catheter out and I guess I wont really know until my first VCUG but I am worried. buccal mucosa 2 stage urethroplasty
Did you ever try peeing normally (through your penis) while having the suprapubic catheter attached to a bag (in other words, suprapubic not valved off)?
Ken Theriot says
No Andy. there as never an urge to do that since the bladder was emptying into the bag. There were times when I was sitting on the toilet when little would dribble out (a very little). But other than that, no. And the entire reason I was on a SP catheter prior to my surgery was to let the stricture scar down with no stress or strain. He didn’t want urine passing over and around it.