Just finished up with my local urologist. He did a cystoscopy and was only able to get the 16Fr scope in a little bit that is where my structure happens to be.
He wants to dilate me in a few weeks since I have been on self dilation for 12 years with no real issues except in the last 3-4 weeks.
We discussed a perineal urethrostomy and he said that was possible but he hated to go that route if I could get a year or more out of another dilation.