The reason I have a suprapubic catheter is due to my stricture of the urethra. I know, I didn’t know what that meant either. So you can be one step ahead of me by knowing that a stricture of the urethra is basically scar tissue inside the urethra that grows large enough to prevent you from going “number 1.” See the picture to the left for a unisex visual of a stricture) People usually don’t know what caused their stricture. It can be any trauma to the area from the past several years. that could be getting schwacked in the nads (guys), or damage done by a catheter inserted during surgery, any number of things. Sometimes it’s venereal disease. Anyway, here is the story of how I found out I had one of these.
My primary care doctor diagnosed me 6 months earlier with an enlarged prostate, medically called benign prostate hyperplasia. Besides thinking I was several years too young for that, I just accepted it and took the medication (terazocin). But my pee stream was getting weaker and weaker until finally I got a consult to visit the urologist. One week before the urology appointment, I woke up one day and could not pee at all. so off to the emergency room I went.
What followed was a period of time I will forever remember as “the day the 10 on my pain scale was readjusted – by a lot.” Typically, an ER nurse would encounter little or no resistance when inserting a catheter up through a male patient’s “wee-wee”. And when they do, it’s usually because the patient got nervous and tensed up, squeezing the sphincter and inhibiting the insertion of the tube. Still, that is usually overcome by taking a few extra seconds for the patient to relax, and then insertion can continue. So when my nurse couldn’t push the tube in any more, he assumed I was just tense. And boy was I ever! It hurt like no pain I’ve ever had. My screams told everyone around that this was the case.
Well, the nurse simply said to relax as he continued to push, and I continued to scream. After a minute or two of this, he gave up and said he’d leave for a few minutes to give me time to relax. Yeah, right! Well after about 15 minutes, a different nurse came in. She said she would definitely get it in (was this a game to them?). I told her I could not go through that again without something for the pain, and wasn’t there some anesthetic gel or something they could apply. She said something to the effect of “well, do you want us to poke a hole in your belly and drain it that way?” in a VERY sarcastic tone of voice. If I had only known then that THAT is exactly what was to happen, I might have been able to avoid more searing pain. Anyway, she said “here we go,” and proceeded to try again, just like the first nurse, with no anesthetic. It hurt worse than the first time. She screamed at me to relax, and shouted that women do this all the time in child brith – “just pant!” Oh my god, what?! If it hadn’t been for the doctor walking in at that exact time, and telling her not to push it if she couldn’t get it in, I don’t know how much longer she would have pushed and shoved.
The problem seemed to be that neither nurse even considered that it could be a stricture of the urethra, since they are much less common than the trouble caused by nervous patients clamping down.
Shortly after she stopped the second effort, the nurse left and I was alone in this little room for some time, whimpering like a baby. After about 30 minutes, some doctors from Urology arrived. And I told them I had been in so much pain that I don’t know how I could endure any more without some sort of anesthetic. Once of the docs said “you mean like THIS?” He held up a tube of Lidocaine gel. Well where the heck was that when the nurses were trying to shove this thing in me? At the very least, the second nurse could have done, after I had been through so much pain already. Anyway, it was not a surprise that the urology folks couldn’t get it in either, but at least there was not so much pain this time. And they stopped after just about 10-15 seconds, realizing the strong possibility of a urethral stricture.
So I was discharged from the ER and walked up to the urology clinic where they gave me more lidocaine gel, and then put a camera into my urethra – yes, using the normal route (if you’re a guy, I’ll bet you’re cringing in a very predictable way right now:)). What they saw was a misshapen mass of scar tissue completely obstructing the path to my bladder. The doc said the damage done by the ER nurses trying to shove the catheter in had obliterated the stricture, basically closing off any opening there may have been. Wow.
So the next step was to have dye injected into my urethra under an x-ray to see if at least liquid could get through. Nope. There was no way of getting a catheter into me the normal way – through the urethra. The only other option was to have a suprapubic catheter inserted. See our post on those in the article What Is A Suprapubic Catheter? So they admitted me to the hospital and put the thing inside me that night. Ironically, there was literally no pain involved in that at all, which was mostly due to the Fentanyl they fed me through the IV. OK, it was entirely due to that. But the application of even a little pain medication can sure makes an amazing difference.
Now interestingly enough, considering that it is really just a bunch of scar tissue, a stricture of the urethra is, according to my urologist, about the hardest thing to fix next to prostate cancer. They have to up-size the catheter monthly at least 3 times (the first one was a small 10 French size – see our post on catheter gauges Primer On Urinary Catheters And Catheter Gauges). Once the catheter is large (wide) enough, they can stick a camera down through the bladder as well as one up the other way to get the most accurate picture possible of the stricture. Only then can they determine which of the many types of treatment will be best for me.
This is a long-term process – possibly lasting up to a year. So as I go through each day in my new reality, I will pass along any tips I pick up or devise via this website. That’s the reason I started it. Might as well wring some good out of this if I can, right?
If you have any questions about strictures, or what it’s like to go through this, please leave a comment below.
Mrs. Hawaii says
Aloha, Hi Ken! Thanks so much for explaining ’bout Urethra Strictures with your first hand PAINFUL experience. I am married to an older man who’s 88 now that now in Hawaii there is no urologist so I take him to the ER when it’s time to change his indwelling catheter each month. Last time the caseworker asked for us to have a nurse come to our home to change it so now the nurse came wanting to replace the indwelling catheter with a “Condom” catheter. My husband has had four urethra stricture surgeries in the past so I just read for the very first time that the stricture will come back with scar tissue growing back if the catheter is removed? If anyone knows please advise me as a woman apparently I would not understand these things but my husband had prostate cancer so now we’re thinking NOT to remove the catheter to stick with it since it’s working. Does anyone know IF you use a condom catheter it appears flimsy and from some reports comes off easily just like the word “Condom” implies. At this point, I am so sorry it was that PAINFUL for you as my husband I watched twice while the urologist he did have do urethra stricture surgery without anesthesia so he must be tough huh? In the past it was surgery at the hospital but the last few times it happened at the doctor’s office but then we were only given a leg bag instead of the bed bag so we’re no longer allowed to go to see him. Now then, with the bed bag just wondering if anyone knows ’bout these “Condom” catheters as one P. A. told us in the ER now it’s trip #16 that no one uses them since the 60’s? Wow, this isn’t Waikiki on Oahu instead it’s a real remote with few doctors not many specialists. My husband appears to be doing better with the Foley Catheter but the nurse that came to our home wants to remove the catheter replace it with the “Condom” Catheter then I’m worried the urethra stricture as a direct result of removing the Foley Catheter may grow back so what would you do? Now the new nurse that replaced the previous one who wanted to make sure my husband doesn’t end up in the ER or else she’ll get FIRED is insisting on using this same “Condom” Catheter? Then my older husband couldn’t hear her so now he changed his mind wanting to keep his Foley Catheter. I’m just confused but yet reading your story probably sealed his fate because after typing all of this I plan to give him this link to look online so thanks for writing your story even tho’ it was so PAINFUL hopefully by now you’re doing much better. Any advice as I am Medically Naive would be appreciated. Cut to the Chase: My real question is does anyone know if it’s true that once a Foley Catheter is removed then the stricture grows back? Age 88 I don’t want my husband to have to undergo surgery nor do we have a urologist so maybe it’s best to stick with what we have = Foley Catheter.
Ken Theriot says
Mrs. Hawaii. First of all – You’re welcome:). Next, thanks for posting your situation! It sounds frustrating. Remember that I am not a medical professional. So take my advice accordingly. My doctor told me that if I were in my 80s or 90s, it might be appropriate to have urethrotomy (where they just insert a scope with a knife and slice away the stricture) – which is what it sounds like your husband had. Trust me, nobody could do urethroplasty without anesthesia. Being in my 40s at the time, the odds of the stricture coming back after a simple urethrotomy are too high (roughly 50% or more) for someone under 75 or 80. At your husband’s age, it might be OK to do the urethrotomy as it’s much less invasive and even if he has to have it done again, it won’t be that many times, likely. To answer your question about removing the foley and having that be the cause of the stricture growing back – I have not heard that at all. If the urethra is going to scar again at the removal site, a Foley is not going to prevent that. So removing it or keeping it in will likely make no difference. My advice would be to make his like easier without the Foley and if the stricture grows back, it was going to do that anyway – Foley or not. I hope that helps. Good luck to you both!