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I go in tomorrow morning for my permanent urethrostomy. For those that don’t know what that is, its where they make an incision in the perinium, slice open the urethra, then sew the skin to the edges, making a new opening just below the testicles. Afterward the urethra is similar in length to a woman’s.
The decision didn’t come lightly. I was supposed to have a urethroplasty with a buccal graft last month, but when they scoped me before the surgery they found that my stricture was 6.2 cm, and most of that is completely obliterated. That left me with two options. One is a much more extensive urethroplasty involving buccal and rectal tissue, and possibly even skin from my forearm — and absolutely no stats on how successful it might be. The other choice is urethrostomy, which is what I chose.
The negative effects are few, but definitely noticeable…
1. Sitting to pee.
2. Ejaculation occurs from the new opening as well, making it impossible to have kids the natural way.
3. The risk of UTIs goes up, to more or less the same as a woman.
There are several advantages as well…
1. The risk of recurrence is extremely low, especially when the area has never had radiation exposure.
2. It’s a very simple operation with a short recovery.
3. A shorter urethra means that inserting a catheter or scope is far easier.
4. Birth control is no longer an issue.
5. Bladder control and erectile function are not affected.
It’s not an ideal cure, but it’s better than using catheters for the rest of my life. I’ll let everyone know how it all turns out.
Clayton
I made it through surgery, and everything went great. The tissue from the stricture to the bladder was healthy and normal, which means they didn’t have to use a graft, and my prostate and external sphincter look fine.
The remaining urethra is 30F wide, and they placed a 16F catheter which they’ll remove Wednesday morning and send me home. They already took out the suprapubic. So, I have only a day before I start peeing on my own. To say I’m relieved is an understatement.
The surgery lasted just over three hours overall, and I’ll be in here for two nights. After six weeks my restrictions will be lifted, which are basically there to protect the incision from opening, and I’ll be able to shower tomorrow if I want.
So far there hasn’t been any swelling of my penis or testicles, or discoloration either. The underside of my scrotum is covered with a bandage though, so it might be down there. My surgeon warned that the swelling is sometimes delayed as well.
Pain is present, but easily handled by oxycodone so far. I’m hoping to move to acetaminophen tomorrow. It’s like a pinching feeling, but also an ache too. Not the worst thing I’ve ever felt, that’s for sure.
I’ll post an update tomorrow, but so far so good.
Clayton
Clayton,
I am glad to here that everything went well. I am sure you will very happy in the coming days.
Steve
Clayton
Great news! Just do what they tell you and catch up on netflix, books or whatever you enjoy. The time went really fast for me. I hope everything continues to improve for you.
greg
Greg and Steve,
Thanks for all the kind words.I feel pretty good today. I’m still in some discomfort, but it’s not as bad as yesterday. They’ll have me walk a little later this evening.
Tomorrow could be interesting. They’re planning on filling up my bladder through the catheter, then they’ll pull the catheter and have me urinate, then measure the output and compare it to what they put in. The interesting part would be the drive home with a bladder that’s been slowly shrinking for the past six months. My surgeon said it takes about a month to really see a big improvement in bladder capacity, and three months until it completely returns to normal.
One interesting thing about this surgery is the lack of dribbling afterward. After a urethroplasty it’s expected for a while to have some dribbling after you go, since urine is still sitting in the bulbar portion of the urethra, and the muscles used to expel everything are still strengthening. With a urethrostomy, however, its a straight shot down from the bladder to the new opening, which means a more complete draining from the beginning. My urethra is now only about two inches long, which is shorter than the stricture.
I’ll post another update tomorrow.
Clayton
I didn’t get a chance to post anything yesterday, it was a bit hectic getting discharged and travelling home.
The day started out with a visit from urology, and they decided it was best to simply remove the catheter and wait for my bladder to fill up naturally. After about an hour I felt the urge and hobbled into the bathroom, and instantly I felt a huge relief, and surprisingly no stinging or pain of any kind. My urethra is now over 30F, so my bladder empties in seconds.
After determining that most of my urgency was simply spasms, I went ahead and took some oxybutynin along with the oxycodone. That helped me get home without an accident.
Today I’m only on acetaminophen, but things are very stiff when I’m moving around. The swelling started to increase the day after the surgery, and yesterday continued to grow. Now it’s stable, but my scrotum and perinium are quite enlarged. Not to an extreme level though, the skin isn’t tight.
The first several times of urinating was messy. It ended up everywhere before finally making it into the toilet. Today it’s settling down though. My surgeon said that once the swelling goes down it will become more manageable.
Clayton
clayton
glad to hear you made it home. That is where the real healing begins. I am glad it worked out for you.
Take it easy and enjoy the time at rest. My swelling went down fairly quickly.
greg
Clayton,
It so great to hear you are doing well. Please keep letting us know how you are doing.
I am traveling from Florida to Illinois for my operation a week from Saturday. Two day later, on the 12th I have my surgery. I will try to do the great job that you and Greg have done reporting your progress.
Steve
I was able to take a shower on Thursday, post-op day 3, which went a long ways in making me feel human again. The swelling started to go down that day as well.
On Friday I got sick to my stomach, which is an unfortunate part of every operation. The anesthesia puts your digestive system to sleep, and the opioids given for pain keep them groggy. Make sure you take stool softeners right away to get things moving. Most of the time you end up with constipation, but sometimes your body goes overboard in its reaction and ends up causing diarrhea to clear the intestines out. Neither is pleasurable.
It’s now Saturday night, and my stomach is beginning to finally settle down. The swelling is really down a lot in my scrotum, but the perinium is still angry looking. Both are somewhat bruised.
Walking is becoming easier, but still not comfortable.
Urinating changes daily as the swelling disappears. At times it aims straight down like it’s supposed to, other times it’s a wonder that it stays in the bowl. The stream is still strong though, and my bladder empties in seconds.
Clayton
clayton
sounds like good progress for you. I know the first week or so, my appetite was mia. It came back but took a little while. I am glad that you are able to pass urine well.
It took me quite some time to get back to normal walking. I went out today just shy of 1 month post surgery and I felt almost normal walking. The stitches are pulling and poking less and less and the soreness is almost gone. I’ve a full size truck and it is easier to get in and out now also.
greg
Clayton,
Glad to here you are doing better. Only 8 days to surgery for me. I hope I do as well as you.Greg,
I am sure they will find why you can’t pee. Ask for a Cat Scan for stones. My Cat Scan came back negative. No stones. Please keep reporting, as I am judging my healing after surgery based on you and Clayton’s progress. How is driving in a car now?Steve
I haven’t even attempted to get in my pickup these last 6 months. Fortunately I also have a Volvo SUV that’s a lot easier to get in and out of. I’m hoping that I can start driving again as soon as I recover from this surgery.
One thing I’ve noticed that I’m not sure is common of all these surgeries or just this particular one, is that my nocturnal erections are uncomfortable only in the scrotum and perinium, like the tissue is being pulled. The penis itself feels normal.
Clayton
Greg,
Something else I wanted to ask you… How is your wound where the suprapubic catheter was inserted? Mine is still really tender, although it’s not weeping or anything.Steve,
Thanks for the support. I’m sure yours will go just fine. It’s easy to get scared when they throw out numbers like 86% cure rate or whatever. We instinctively worry that we’ll be in that 14%. That number is misleading, however, as even the vast majority of that smaller number turn out fine after a simple procedure. It’s not a surgery that any of us look forward to, but it’s not a diagnosis that any of us wanted either. In the long run we’re actually incredibly lucky to be living in a time where there is a treatment for what we have. A generation ago they weren’t so fortunate. I know I’ll be here through your recovery to help in whatever way I can.Clayton
Clayton
I still have the suprapubic in place since they are a little hesitant (along with me) to remove it till they investigate me a little more. Having said that I can’t recall if I shared that this is my second time around with a suprapubic? First time was 18 years ago when I first developed the stricture and was treated with a urethrotomy. That time when they removed it, they basically pulled it and put a bandage over it. I don’t remember having issues beyond a few days. Then I was in my 30’s and felt like I could heal a broken bone overnight. Now in my 50’s it seems like a sprain or muscle pull is a lifetime (or at least several months) disability. I have been a little concerned myself about how that will heal. I am at the 4 month mark, and having it that long makes me feel like it may take a little longer to heal. My Urologist Nurse tells me that it will just heal on it’s own and that the bladder will close up with in about 10 minutes. That is amazing to me. I’d imagine that it might weep for a while and that seems a little weird. If it becomes painful or doesn’t stop in a day or two I would call them. I don’t recall much about my previous removal so it must have gone ok?
greg
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