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Old 06-20-2012, 12:21 PM   #3
chillipulp chillipulp is offline
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Re: urethral stricture - urethrotomy questions

Quote:
Originally Posted by lewisosd View Post
Last Thursday (22/03/12) I underwent a rigid cystoscopy with optical urethrotomy to widen a bulbar urethral stricture.

... When can I begin sexual relations again? My urologist said straight away whereas the nurse practitioner who tried to teach me self dilation (and failed!) said give it a couple of weeks. I am finding myself getting more sexually aroused each day and am struggling to keep the beast in it's cage!

What are other peoples experiences with urethrotomy's and their sucess rate?
"The curative success rate of internal urethrotomy is approximately 20%."
(Eur Urol 2007;51:1089-92)

You might do better than that, with a short, single, previously untreated, flimsy stricture located in the bulbar urethra.

You've already had recurrence following earlier dilatations (though quite a long time ago, which is good).

In the event of recurrence, further urethrotomies would not be curative. In that case, you would be well advised to consider expert urethroplasty.

("Three surgeons perform half the urethroplasties in the UK each year"; "Most urologists in the United States have little experience with urethroplasty surgery"; "Most Dutch urologists only consider urethroplasty after failed direct vision internal urethrotomy. Endoscopic procedures are widely used, even though the risk of recurrence after two previous failures is virtually 100%".)

As the contradiction between the urologist and the nurse suggests, nobody really knows, and you're left to rely on your own judgement. At least you still get aroused, so be glad you dodged the bullet this time.

Quote:
EDITORIAL COMMENT

... this article also casts doubt on the practice of self-catheterization to try to keep strictures open after urethrotomy.

Of these patients 73% had recurrence on a self-catheterization regimen and another 18% had so much pain with catheter passage that they had to abandon it. Again, few reconstructive urologists attempt this maneuver since it always seems to fail, not to mention that it unnecessarily condemns the patient to a lifetime of painful self-catheterization, which would not be necessary after surgical cure by open urethroplasty.

An excellent study by Greenwell et al suggests that self-catheterization has no value, at least for anterior strictures,1 and the current authors add doubt about its usefulness for posterior urethral distraction injuries. This suboptimal management scheme remains wildly popular, judging by the referral population seen at our clinic, despite the real doubts as to its efficacy. It is another specter in need of a stake to the heart, in my opinion.

(THE JOURNAL OF UROLOGY, Vol. 178, 1656-1658, October 2007)
Quote:
Self-catheterization is a traumatic maneuver that most patients view with considerable disdain as a painful, time-consuming, embarrassing, difficult and unnatural practice they would gladly abandon if given the choice. False passages will develop in most cases over time, further complicating the problem. Today we can and must do better.

(THE JOURNAL OF UROLOGY, Vol. 181, 953-955, March 2009)

Last edited by chillipulp; 06-20-2012 at 12:44 PM.

 
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