I recently had diagnostic surgery to pinpoint the length and location of my urethral stricture. I wrote about that procedure here – Results Of My Combined Antegrade And Retrograde Urethrogram. My urologists have taken to calling this an “up-downogram.”
Anyway, today I saw the doctor, who showed me the image of the stricture. It’s in the area called the bulbar-membranous urethra. It’s sort of right where the bulbous area ends and the membranous area begins. See the picture to the left, which IS NOT a pic of me, BTW. Basically that means it’s not really in the “wee-wee” at all, but just below the prostate. That means that the “fix” surgery, which will be an end-to-end anastomosis (a type of urethroplasty), will not require the docs to – guys, you might as well cringe now – slice open my “little fella.” Instead, they will go in via the perineum.
So though it may be a bit painful to sit down for awhile after the surgery – which they scheduled today for about 6 weeks from now – it makes me feel a bit better about things. It isn’t logical. It’s just as cringe-worthy to talk about cutting into what amounts to “the taint.” But it is what it is.
I continue to be amazed at how much trouble can be caused by a little bit of scar tissue about the size of the head of a pin, or a grain of rice, or something else really small like that.
Today was another step forward in this whole journey. And I still have no idea what caused the stricture. That’s life, I guess.
Ken – I’m in a similar boat. I’m actually heading to Duke University to meet up with a doc there who may be able to help me. My stricture is the result from trauma, so no mystery for me.
Who’s your doc and does he do these procedures routinely? From my research, the success of these procedures is highly dependent on the skill of the surgeon.
Anyway, good luck and if you have the time, drop me a note back.
Hi Ken,
Nice to know we’re not alone huh? My doctor is Dr. Thomas Rozanski, who does indeed routinely perform urethroplasty. He’s also done a lot of training and publishing in the treatment of strictures. So I think I’m pretty lucky.
Good luck with your treatment!
Ken
Ken,
Thanks for the note…I just got back from Duke this evening. Really good doctor (Peterson). Did the RUG and scope today. Unfortunately for me, my stricture is within the membranous urethra and doc has recommended against a Urethraplasty. I’m 39 and feels its too risky of a procedure (incontinence). Looks like I’m on deck for dilation in a month or so.
Hope your recovery is going well.
As for the gent in Utah……I highly recommend you get consider talking with Dr. Joel Gelman.
https://www.centerforreconstructiveurology.org/gelman.htm
I would have gone to him, but I’m on the east coast. This guy is supposed to be the “man” for Urethraplasty. I called him for a consult and he was excellent, called me right back and was very very kind.
Good luck to you both.
Best..
Kenny
Kenny,
If I were you, I would REALLY try for a second opinion on that. My stricture was in the bulbar-membranous urethra. It’s sort of right where the bulbous area ends and the membranous area begins. I wrote about it and put up a diagram on my post – https://livingwithacatheter.com/saw-my-urethral-stricture-on-film-today/
There was no such mention of that kind of risk from my docs. Though things may be different if the stricture is that much further back than mine. Certainly, it is scary, especially at your young age, to think about incontinence or impotence.
Dilation really seems to be at the bottom of the totem pole for effectiveness, and needs to be repeated on a regular basis, since it has a zero percent long-term success rate.
Since it appears you only had the retrograde urethrogram, and they are basing all this on just that, I would also ask a doctor about getting a much more accurate location and length assessment via an antegrade-retrograde urethrogram (all my docs called this an “up-down-o-gram”). Yes, they’d have to make a suprapubic hole (if you don’t already have one), but siting from both directions gives a much more accurate picture of location and size than just the retrograde scoping – say my docs. But as with everything, you should check with your own medical pros on this.
Good luck with everything!
Ken
This is a great website. Thank you for doing this. It’s very helpful to know other men have gone through this. I am currently being evaluated for urethroplasy to correct a 3 mm stricture which was discovered after a pin-head size kidney stone blocked my urine flow. I have probably had this thing all my life since I have always had a week urine flow compared to other guys. It has never caused me real trouble until the stone. My doctor is Jeremy Myers, University of Utah and says he does about 50 of these surgeries a year. He tells me, in my case he will probably need to use a graft because the stricture is too long. He says his success rate is about 75% to 85% based on follow up monitoring and scoping. He says the 90% rate reported normally is probably not accurate because it is based on patient return not on careful follow up. Sounds reasonable. The surgery doesn’t worry me much but I am concerned about UTI’s and hospital acquired infections as well as trying to sleep while tethered to a urinary bag for 4 weeks.
Also, how do you shower and still keep the whole system sanitary?
Hi Ray. Thanks for comment on the site! It’s interesting that your doc says his rate is lower. My doctor, Dr. Thomas Rozanski) told me straight to my face that it’s 93% long-term. And he is one of the leading urologists doing this. There aren’t many, so it’s a small community even within the field of urology. They probably know each other. Maybe it’s a stat cluster.
Either way, it sounds like your stricture is about the same size as mine. Your doctor said 3 millimeters needed a graft? That’s surprising too. 3 centimeters, yeah. But there are some doctors, mostly in India, that due buccal grafts on ALL end-to-ends, just to increase the likelihood of success. But in the world of strictures, 3 millimeters is very small.
Anyway, I think I can help put your mind at ease on the other topics. ON the UTI issue, all my best information is on my post here: https://livingwithacatheter.com/urinary-tract-infection-and-catheter-care/ The highlights are that once you have an indwelling catheter, you ALREADY are colonized with the bacteria. The only question is whether or not they invade your tissues (which is when you get the UTI). So much of the hype about trying to sanitize your bags, every time you change them, etc. is not supported by the evidence. But read the whole thing. As for showering – the ONE UTI I got in 6 months was at the beginning when I was showering with the catheter open and hanging – no bag. I got nervous after that and tried to absolutely limit the time my catheter was open to the elements. So I wore my bedside bag in the shower. Whenever I changed bags, I didn’t want more than about 3-5 seconds to pass. I never had another UTI. I know this is a bit at odds with the whole “you’re already colonized” data. So just know that my story is anectdotal and may not work for everyone. It may well have been other things I did (see the article) that prevented another UTI.
Thanks again for the comment/questions. I hope that helped! Good luck with your ordeal!!
Cheers,
Ken
Hi Ken,
I’m almost certainly wrong about the length. Likely he said 3 cm and I heard 3 mm. I can’t imagine a restriction that’s more than an inch long but it probably must be. I’m scheduled for a second retrograde urethrogram tomorrow and will know more then, including when the surgery will be. Thanks for the link on catheter care and also the suggestion on showering. I would surely have gone ahead disconnected the bag.
The urologist I am seeing, Dr. Meyers, specializes in trauma surgery and there is a video of a lecture he gave at the University of Utah on common urinary trauma injuries and surgeries to repair them on the link below. It may be of interest to the earlier Ken. It’s about an hour long. The quality is not great but the information is helpful. Click on the “ Video and News” tab at the upper left.
https://healthcare.utah.edu/fad/mddetail.php?physicianID=u0682292#tabAcademic
Congratulations on being tether free in few days. Hope your pain begins to decline as well.
Thanks again for the help and for this website. It’s very helpful, nicely organized and easy to view. Did you build this yourself?
Thanks for that Ray. I’ll take a look. And about this website – yes, I did build it myself;). Thanks for the feedback! And good luck!
Ken
So you were that close to the external sphincter and they were still able to do end-to-end? I’m afraid….
I had an episode of AUR way back in late 2009 and went to the ER and they were unable to cath me. However, they were able to open me up enough where I could once again pee (very slowly) and gave me a consult to a urologist. However, a few days later, I felt a pop down there and I was back to normal. My primary care doc told me to hold off on the surgery due to a few other health issues, so it ended up being put on the back burner for a while. In February 2011, I was having problems again, went to a urologist, and when they tried to cys-scope me, they weren’t able to get any farther than an inch from the meatus. So they scheduled a urethrotomy two weeks later. I didn’t last that long and was in the ER two days later. After 5 attempts, they took me to the OR. The urologist said that I had so many false passages and strictures that he was surprised that he could get the guidewire in. (I’ve had fairly constant UTI’s throughout my life ravaging my urethra – at least two or three a year. He also said that I was had at most a 10 Fr Lumen at the widest and a 2 Fr at the worst). So I was cathed with a 20Fr catheter for a month before he could schedule me for a urethrotomy. He went in for the urethrotomy, but there was nothing to do as the false passages all closed up in that month. However, two weeks later, I went from a 22 Fr lumen down to a 14 Fr. So we then re-did the urethrotomy with a 18 Fr Foley and 5 days of cath time. After this, I started intermittent cathing using a 18 Fr rubber catheter, then going to 16 Fr. hydrophilic after the rubber catheter started irritating the urethra.. I stayed on the 16 for about 14 months (daily), then going down to a 14, then a 12, then finally a 10 before I had another urethrotomy last Friday. The grind will start over once I get rid of this blasted foley (nothing hurts more than a foley indwelling catheter with bladder spasms at pain 9/10 occuring every 15 minutes of the waking day).
My stricture (this last time) was at the same place as yours and is about 2.5 cm long. I’m afraid of the urethroplasty because of the length of surgery and the lithometric position your legs need to stay in. I had a blood clot a few years ago, so I’m sensitive to the dangers associated with the lithometric position. My uro doctor told me that I had a 33% chance of severe complications due to the surgery itself… That’s why I’m forcing myself to suffer through the urethrotomy. Maybe I need to find a practice that does urethroplasties and see what they say.. (I’m in the Austin, TX area)
Jeffrey,
Since you are in Austin, I would highly recommend contacting Dr. Rozanski’s office (San Antonio). The contact information is on this page (a little more than half-way down): https://urology.uthscsa.edu/bio.html. When you find his bio, underneath will be a section called “New Patients” giving you phone number and links, as well as instructions on how to schedule an appointment. He is the one who did my surgery, and he he is one of the best in the country.
My story is very similar to yours as far as the acute urinary retention (UAR) and the ER’s failed attempts to insert a catheter. But it wasn’t long (that very day, actually) that Urology diagnosed my stricture via both cytoscope and retrograde urethrogram. From that point forward, I was on the path toward urethroplasty. They don’t even consider urethrotomy (which is why I’m surprised you had it done), due to its poor long-term success rate.
As for the lithotomy position (https://en.wikipedia.org/wiki/Lithotomy_position), it is pretty standard now, for most surgeries, not just just those with lithotomy position, to apply pressure cuffs to the legs. These continuously inflate and deflate to prevent blood clots. That should help allay your fears on that score.
Urethroplasty is the gold standard of urethral stricture repair. I would not hesitate to go for that if you want a high chance (usually over 90%) of long-term success.
I hope that helps.
Good luck!
Ken
Just wanted to let you know that I just set up a forum on the site! It might make it easier for all of us to keep up with each other rather than having to use the comments sections across multiple posts. Right now I have a “General Discussion” forum and a “Urethral Strictures And Their Treatments” forum. You can find the forums page here: https://livingwithacatheter.com/community-forums/
I’ll be putting this comment on multiple posts so everyone who has been involved in our discussions is aware, so I apologize in advance for the possible duplicate e-mails you may get.
Cheers!
Ken