Hi crazytrain, its incredible how similar your story is to mine. I'm 31 years old and was diagnosed with a proximal bulbar stricture almost 2 years ago. Im from South America and I was in Puerto Rico last week for work and I almost went into urinary retention. Since my diagnosis, I have thought about getting a urethroplasty, however, up until July I really did not think I needed one since I had read in various papers (one by Dr. Mundy in London) that only if you’re experiencing UTIs, pain, episodes of urinary retention and a flow rate below 5 ml/sec you should look into getting treatment. I have never had a UTI before, no pain while urinating, simply a slow, weak stream. However, since July things have begun changing, every 2 or 3 weeks I will notice how my stream gets even smaller and weaker to the point where at times I am only releasing drops, this happens for 2 or 3 days and then it reverts back to the usual stream. I thought I could wait a little bit more to see if this changed, however, as I said before, I almost went into urinary retention last week. I was lucky enough that as I tried going to the bathroom one last time (at the ER) I felt like somethingceded’ and I was able to release urine. I had already accepted in my head that I would have to get the suprapubic tube in! Close call!! This happened on november 6th and your post was two days after, I actually read it 2 hours after you wrote it but had not had time to reply.
I’m afraid urethroplasty is my best option and I am also a little skeptical but conscious that this is a possible long-term solution to my problem. I am actually flying at this exact moment from Detroit from seeing the surgeon that will be operating on me in december. I actually went to John Hopkins almost two years ago to get myself checked out, however I only got a RUG done at that time and I decided againt further treatment (wait and see strategy).
My surgeon in Detroit is considering doing a buccal mucosa graft urethroplasty placed ventrally even though my stricutre is suspected to be smaller than 2 cm, the reason for this is that his experience (performed over 600 urethroplasties) has shown that sexual complications run towards zero using a BMG. This makes sense as he does not need to transect the urethra or mobilize as is necessary when an end to end anastomosis is accomplished. Have you done some reasearch on this as well? At first I was freaked out at getting my cheek harvested, however it now makes sense to me now that this is a very good option. I guess if the graft fails I can always have a second opportunity and get another graft there or have the scar tissue excised and have end to end anastomosis performed.
Anyway, I see that we are both in a similar situation and just wanted to send some notes on my experience and thoughts.
Cheers,
Dan