Reduced flow 3 weeks after end to end urethroplasty

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Hi, I am a 25 year old male who had an end-to-end urethroplasty last month to fix a ~10mm stricture in the bulbar urethra (perineum incision). I had a urethrotomy in June last year which fixed the problem temporarily, but the stricture returned after a couple of months.

After the urethroplasty, I was kept in the hospital overnight and then discharged the following afternoon with antibiotics and very minimal post-care advice. (I found this, which was very helpful http://www.med.umich.edu/1libr/urology/postcare/urethroplasty.htm)

The first few days at home were pretty painful and uncomfortable. but after the pain went away and my partner brought me a donut cushion so that I could sit at my PC, things were alright. I had to wear a foley catheter for 2 weeks.

After 15 days the day finally came to return to the hospital for a urethrogram and catheter removal. The staff laid me down on the table and explained that they were going to insert a very small juvenile catheter into the urethra alongside the existing one, to inject the contrast down the urethra and into the bladder. They inflated the balloon in my urethra slightly to prevent it slipping out, which was quite painful and uncomfortable, but I managed long enough for the staff to get their images – which showed no leaks or narrowing.

I was then sent next door to get the catheter removed by a nurse – slowly and painfully, to prevent any damage to the surgery site. After I left I made my way to the toilet to pee – with excellent flow. No flow tests were done so unfortunately I can’t report my exact flow.

So that was around 10 days ago. Since then I’ve been mostly sitting on my PC gaming (The nurse told me I could start sitting down without the donut cushion as long as it wasn’t painful – she was happy with how well the wound had healed), eating out with my partner, and also driving around a bit now that I’m permitted to. However, over the last few days I’ve noticed my flow has drastically reduced – almost as bad it was before the urethroplasty (I estimate around 7mL/s). Frankly, I’m kind of worried. However it has only been 3 weeks since the surgery so I’m hoping it’s just part of the healing process, or still inflamed due to the catheter, or something. Unfortunately I can’t contact the surgeon or nurse at the hospital about it since it’s a long weekend here. I think I’m gonna lose my mind if I have to get another urethroplasty. I need to go back to work.

Can anyone weigh in? Am I worrying over nothing?

Thanks, and sorry for the disorganised wall of text

[TTTTT]

Update, in case it helps anyone looking for info.

Called my urologist a couple of days after I made the original post. Went in for a flow test and bladder scan. My flow was around 9-10ml/s, which he said was “adequate”, and there was very little urine left in the bladder post-void. He didn’t seem concerned. Mentioned something about the possibility of a skin flap at the repair site interfering with flow, or something. I couldn’t speak with him at length about it because he rushed me out the door.

2 weeks later, flow is still pretty average. At least it’s not getting worse, though. I’m going back in for another flow test in a couple more weeks.

I’ll be 6 weeks post-op this Thursday, so I can go back to work and havin’ sex next week. Hopefully I don’t break anything.

[TTTTT]

Saw the urologist again today.

It’s now 7 weeks post-urethroplasty. Flow has basically halved since my last visit. And now I’m retaining 300mL or so in my bladder. Fun times.

Doc is gonna do a cystoscopy as soon as he can. He basically presented me with 3 options depending on what he finds;

1) Urethrotomy

2) Buccal mucosa urethroplasty

3) Inserting a stent into the urethra.

I don’t like the idea of the stent, but the doc was leaning heavily towards this option. on the plus side, I wouldn’t have to take any time off work, and it’s a simple day op. I’m just worried about it getting dislodged, or causing discomfort, or whatever. Especially considering I do weight training sometimes.

I’m anxious to see what the cystoscopy reveals. Maybe the catheter screwed something up, maybe the surgery site got infected, who knows. just a waiting game now. Hopefully my waterworks don’t completely cease to function in the meantime.

[poortonykrause]

Hi,

I’m very sorry to hear that – I had to go through a urethroplasty as well and the whole process was very difficult. End-to-end urethroplasty has a 99% success rate. If yours did not work out, it is your doctor’s fault. Can I recommend looking up Dr. Gelman in Orange, CA? He did mine (BMG replacement urethroplasty) and it was a success. He is one of the friendliest, professional doctors I have seen as well, and he would answer questions by email or phone anytime of the day or night – literally, I emailed him on a Sunday evening at 9 pm once about a wound healing issue and within minutes he replied asking to see pictures so he could assess whether it was something to be concerned about!

Anyway, I hope you are successful with whatever doctor you choose, but I know the success of this surgery depends a lot on experience and skill.

Peter

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