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Diagnostic test for urethera narrowing

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User
Posted 08 Dec 2022 at 15:10

So I'm about to get my gold seeds implanted tomorrow. And my UHRT is due to start after Xmas.


But I'm terrified of the prospect of my urethera closing up after RT.


Usually it takes me between 3 to 8 seconds to start peeing but sometimes between 15 to 25 seconds 


I would like a diagnostic test to check the state of my urethra but my doctor says I dont need one


He thinks that as it's mainly berween 3 and 8 seconds RT is not likely to cause problems with urethra closure, the prospect of which terrifies me. 


As ever, any thoughts or experiences would be greatly appreciated. 


Best wishes Tony 

Edited by member 08 Dec 2022 at 16:36  | Reason: Not specified

User
Posted 08 Dec 2022 at 15:32
If you do have "flow" issues during RT, you'll probably be prescribed Tamsulosin, which in my case worked wonders. It's an extremely medication for that problem.

Best wishes,

Chris
User
Posted 08 Dec 2022 at 19:48

Tony, I developed a stricture caused by surgery for my prostate removal. My flow would get down to 0.5mls per second and I would then have a dilatation or scar tissue incision to open it up.


I got a bit obsessed with my flow rate but not without reason. I got a Boots urine bottle and would time how long it took me to urinate. When the flow got too slow I would get booked in for a another procedure. 


300ml dividend by say 30 seconds equals an average flow rate of 10mls/ second. My consultant was quite impressed by how accurate the average figure was compared to the hospital test. Of course my do it yourself test does not give peak flow, minimum flow or other data they can get from hospital tests 


Hope things go well for you.


Thanks Chris 

User
Posted 09 Dec 2022 at 23:15

Tony, I just got a Boots urine bottle that has a mls scale on the side. I stood at the toilet with my penis in the bottle,as soon as I started to urinate I looked at my watch and noted the second hand position then noted the second hand position when I stopped urinating. I would probably now use the stopwatch facility on a smart phone, 


Even when my flow was really slow I do not recall there being any hesitation when starting. Not a medic but the hesitation would seem to be more about the ability to open / release the valve, which as suggested my be helped by medication. I seem to recall being given a variety of meds to help with my flow but none of them worked, I suspect that was because my stricture was a mechanical blockage.


I did also have issues with migration of surgery clips into the bladder and / or urethra. One clip was lodged in the urethra and had to be lasered to get it out. 


Added, just noticed you are in Sweden, Boots is a national chain of chemists. I note from you other conversation you are having some scans, the hem o Lok clips I mentioned do not show up on x-rays or MRI they can apparently be seen on CT scans if the machine has been set to detect the right polymer.


Thanks Chris 

Edited by member 09 Dec 2022 at 23:22  | Reason: Not specified

User
Posted 09 Dec 2022 at 23:37

Hi Chris, thanks as always for your replies


Very good tips re measuring, I generally sit down to pee, so will experiment with sitting and standing. Yep will use smartphone timer, its gonna be a bit approximate, but I'll get a reasonable picture I hope.


Spent most of my life in England so know Boots well, wish we had them in Sweden 🤗


Its the first decilitre they're interested in, so maybe sitting wont work. Anyhow not too worried ATM 


Gold seeds inserted today. Very good doctor again, both inserts and biopsy went so smoothly and painlessly.


UHRT scheduled after Xmas, but who knows, one day at a time etc 🙏


 

Edited by member 09 Dec 2022 at 23:43  | Reason: Not specified

User
Posted 10 Dec 2022 at 15:06

Tony , if you have a jug or bottle marked out in mls, just use a felt tip pen at 100,200, 300 and so on. Also remember that 100 mls of water weighs 100g, ( corrected from 100mg,  thanks to Steve, The Analyst). So yo can weigh urine to get volume, the purists do point out the urine may not weigh the same as water.


20mls /second is good. As I said I suspect your issue is more the sphincter release rather than a stricture. 


I keep thinking you have already had surgery and obviously you have not. Medication may be beneficial to you. 


 


Thanks Chris 


 


 


 


 

Edited by member 11 Dec 2022 at 19:35  | Reason: Error with unit of measure.

User
Posted 10 Dec 2022 at 17:03

Thanks as ever Chris, bought a measuring jug and hallelujah excellent result. 


First test 1.1 dl in 10 secs, so much better than the 1 dl in 15 secs benchmark. 


That makes 11 ml a second, which is better or certainly as good as a typical 69 yr male


Such a weight off my mind, can now look forward to my RT without the fear thats been haunting me


Of course there will be new fears and panics and will keep measuring, but its a real boost. The jug cost about a fiver, worth every krona and much much more


Thanks again Chris for all your advice and support. 

User
Posted 11 Dec 2022 at 10:52

I got a bit obsessed by this as a bloke a couple of weeks ahead of me couldn't have his HDR brachytherapy due to narrow urethra and them not being able to get the catheter in during the operation. I built myself a peak flow meter, which showed a flow of 25ml/s just after the start of external beam radiotherapy. (I think it had initially got faster when I started hormone therapy 5 months before - I'm guessing I might have been 15ml/s before diagnosis, but didn't measure it then.)


The first version was peeing into a jug on scales and videoing the weight. Then going through the video slowly to get the weight in grams every second, and the change is the flow rate in ml/s (assuming urine has a specific gravity of 1, which it near enough does unless it's very concentrated). Need to ensure the flow/force of urine stream doesn't subject the jug to extra force as that will give a too high reading. (Ideally pee against something like a spoon held inside the jug to deflect the urine horizontally, but that must not be supported by the jug or anything else on the scales. Having the jug half filled with water to start with improved the accuracy.)


Then I went on to build an electronic version which was a set of cheap kitchen scales bought for the purpose and the circuit inside replaced with a Raspberry Pi Zero computer which calculated and displayed the peak flow (and how long into the pee that was, typically about 5 seconds, and total volume).


It was interesting to see what happened. From memory, I started of with a respectable 25ml/s. Immediately after each external beam radiotherapy it reduced, but recovered later in the day, although there was a slight downward trend during the treatment. From memory, I was around 18ml/sec at the end of the course of radiotherapy, just before my HDR Brachytherapy. After the brachytherapy, it was about 8ml/s, but recovered over the following weeks to about 15ml/s and stayed there. (This was all without Tamsulosin.) I assumed this was my new normal. However, about 5 months later, it started improving further and got back to about 20ml/s. I haven't measured it for a couple of years now, but I don't think it's changed much since then.

Edited by member 11 Dec 2022 at 10:55  | Reason: Not specified

User
Posted 11 Dec 2022 at 19:07

Hi Chris,


I think 100ml of water will.weigh 100g not 100mg.


 


 


Steve

User
Posted 11 Dec 2022 at 19:31

Originally Posted by: Online Community Member


Hi Chris,


I think 100ml of water will.weigh 100g not 100mg.


 


 


Steve



Steve , quite right.


Thanks Chris 

Show Most Thanked Posts
User
Posted 08 Dec 2022 at 15:32
If you do have "flow" issues during RT, you'll probably be prescribed Tamsulosin, which in my case worked wonders. It's an extremely medication for that problem.

Best wishes,

Chris
User
Posted 08 Dec 2022 at 16:44

Hi Chris, thanks very much for reply.


May well start using that medication after RT. But what scares me at the moment is the reason behind the hesitancy.


As you know, RT damages/kills the tissue, cells. The fear I have is that if I have a stricture/narrowing it will close up completely after RT. Then I will face life relying on catheters or having some scary salvage surgery


The treatment is getting close now, then theres no turning back, so I want as much information as possible


I recognise the doctors and nurses have busy lives, resources are limited etc. So they can only give me, or anyone, so much help and attention 


But of course for me, my prostate is the most important one 🤣

Edited by member 08 Dec 2022 at 16:47  | Reason: Not specified

User
Posted 08 Dec 2022 at 19:48

Tony, I developed a stricture caused by surgery for my prostate removal. My flow would get down to 0.5mls per second and I would then have a dilatation or scar tissue incision to open it up.


I got a bit obsessed with my flow rate but not without reason. I got a Boots urine bottle and would time how long it took me to urinate. When the flow got too slow I would get booked in for a another procedure. 


300ml dividend by say 30 seconds equals an average flow rate of 10mls/ second. My consultant was quite impressed by how accurate the average figure was compared to the hospital test. Of course my do it yourself test does not give peak flow, minimum flow or other data they can get from hospital tests 


Hope things go well for you.


Thanks Chris 

User
Posted 08 Dec 2022 at 21:34

Thanks again for the kind reply, Chris. Sorry to hear about your flow issues and the things you needed to do to deal with it. I hope things are better now with you. 


I haven't started to worry about my fliw issues, yet 😱 its the initial hesitancy that's been flagged up as an RT problem 


It seems like 15 seconds is a red flag  and 20 seconds a definite warning sign


But what do I know, am completely confused as I vary between 3 and 15 usually. 


I just hope they will give me a test or picture to confirm state of my urethra 


But anyway I'm going for gold tomorrow 🤣 will talk to doctor about my fears. I may be worrying unduly, and apparently before RT starts, I'll be given an MRI scan. 


Thanks again and very best wishes 


 

User
Posted 09 Dec 2022 at 21:28

Okay all change, apparently its the flow times that are crucial


I need to measure my first decilitre from kick off, so to speak


Need to get a measuring jug, and work out best way to time and measure 

User
Posted 09 Dec 2022 at 23:15

Tony, I just got a Boots urine bottle that has a mls scale on the side. I stood at the toilet with my penis in the bottle,as soon as I started to urinate I looked at my watch and noted the second hand position then noted the second hand position when I stopped urinating. I would probably now use the stopwatch facility on a smart phone, 


Even when my flow was really slow I do not recall there being any hesitation when starting. Not a medic but the hesitation would seem to be more about the ability to open / release the valve, which as suggested my be helped by medication. I seem to recall being given a variety of meds to help with my flow but none of them worked, I suspect that was because my stricture was a mechanical blockage.


I did also have issues with migration of surgery clips into the bladder and / or urethra. One clip was lodged in the urethra and had to be lasered to get it out. 


Added, just noticed you are in Sweden, Boots is a national chain of chemists. I note from you other conversation you are having some scans, the hem o Lok clips I mentioned do not show up on x-rays or MRI they can apparently be seen on CT scans if the machine has been set to detect the right polymer.


Thanks Chris 

Edited by member 09 Dec 2022 at 23:22  | Reason: Not specified

User
Posted 09 Dec 2022 at 23:37

Hi Chris, thanks as always for your replies


Very good tips re measuring, I generally sit down to pee, so will experiment with sitting and standing. Yep will use smartphone timer, its gonna be a bit approximate, but I'll get a reasonable picture I hope.


Spent most of my life in England so know Boots well, wish we had them in Sweden 🤗


Its the first decilitre they're interested in, so maybe sitting wont work. Anyhow not too worried ATM 


Gold seeds inserted today. Very good doctor again, both inserts and biopsy went so smoothly and painlessly.


UHRT scheduled after Xmas, but who knows, one day at a time etc 🙏


 

Edited by member 09 Dec 2022 at 23:43  | Reason: Not specified

User
Posted 10 Dec 2022 at 11:18

Okay, think I'm beginning to understand this flow issue


1 decilitre equals 100 ml, didnt grasp that at first.


I did 2 decilitres in 10 seconds, maybe 2.1 dl. So thats 200 ml at least in 10 secs equals 20 ml per second


So thats good AFAIK, almost too good for a 69 year old with PC, so gonna keep measuring 🤔😅


Anyway I did my first dl in 5 seconds and the benchmark is 15 seconds, so all is well hopefully. 


EDIT 


Okay, got confused over ml and dl again. I realise I need a jug with dl on, before I take any notice of my flow results 


 


 


 


 


 

Edited by member 10 Dec 2022 at 11:51  | Reason: Not specified

User
Posted 10 Dec 2022 at 15:06

Tony , if you have a jug or bottle marked out in mls, just use a felt tip pen at 100,200, 300 and so on. Also remember that 100 mls of water weighs 100g, ( corrected from 100mg,  thanks to Steve, The Analyst). So yo can weigh urine to get volume, the purists do point out the urine may not weigh the same as water.


20mls /second is good. As I said I suspect your issue is more the sphincter release rather than a stricture. 


I keep thinking you have already had surgery and obviously you have not. Medication may be beneficial to you. 


 


Thanks Chris 


 


 


 


 

Edited by member 11 Dec 2022 at 19:35  | Reason: Error with unit of measure.

User
Posted 10 Dec 2022 at 17:03

Thanks as ever Chris, bought a measuring jug and hallelujah excellent result. 


First test 1.1 dl in 10 secs, so much better than the 1 dl in 15 secs benchmark. 


That makes 11 ml a second, which is better or certainly as good as a typical 69 yr male


Such a weight off my mind, can now look forward to my RT without the fear thats been haunting me


Of course there will be new fears and panics and will keep measuring, but its a real boost. The jug cost about a fiver, worth every krona and much much more


Thanks again Chris for all your advice and support. 

User
Posted 11 Dec 2022 at 10:52

I got a bit obsessed by this as a bloke a couple of weeks ahead of me couldn't have his HDR brachytherapy due to narrow urethra and them not being able to get the catheter in during the operation. I built myself a peak flow meter, which showed a flow of 25ml/s just after the start of external beam radiotherapy. (I think it had initially got faster when I started hormone therapy 5 months before - I'm guessing I might have been 15ml/s before diagnosis, but didn't measure it then.)


The first version was peeing into a jug on scales and videoing the weight. Then going through the video slowly to get the weight in grams every second, and the change is the flow rate in ml/s (assuming urine has a specific gravity of 1, which it near enough does unless it's very concentrated). Need to ensure the flow/force of urine stream doesn't subject the jug to extra force as that will give a too high reading. (Ideally pee against something like a spoon held inside the jug to deflect the urine horizontally, but that must not be supported by the jug or anything else on the scales. Having the jug half filled with water to start with improved the accuracy.)


Then I went on to build an electronic version which was a set of cheap kitchen scales bought for the purpose and the circuit inside replaced with a Raspberry Pi Zero computer which calculated and displayed the peak flow (and how long into the pee that was, typically about 5 seconds, and total volume).


It was interesting to see what happened. From memory, I started of with a respectable 25ml/s. Immediately after each external beam radiotherapy it reduced, but recovered later in the day, although there was a slight downward trend during the treatment. From memory, I was around 18ml/sec at the end of the course of radiotherapy, just before my HDR Brachytherapy. After the brachytherapy, it was about 8ml/s, but recovered over the following weeks to about 15ml/s and stayed there. (This was all without Tamsulosin.) I assumed this was my new normal. However, about 5 months later, it started improving further and got back to about 20ml/s. I haven't measured it for a couple of years now, but I don't think it's changed much since then.

Edited by member 11 Dec 2022 at 10:55  | Reason: Not specified

User
Posted 11 Dec 2022 at 12:42

Amazing stuff Andy, unfortunately my Electronics and DIY ineptitude would prevent such engineering feats by me 🤗


Interesting that AFAIC your flow rate dipped about 25 per cent overall pre and post RT


ATM my rate is about 8ml/sec, which is okay I think for someone nearly 70 with PCa. So maybe it will level out at about 6, but dropping as low as 4 at one stage


Been doing my low tech measuring with plastic jug and a mix of one Mississippi two... and smartphone timer.


One dl is taking on average 12. 4 secs, which is better than the 15 red flag benchmark. Will email nurse this evening, see if she thinks thats okay for UHRT


I would like either a proper hospital flow test or some other test before I submit my delicate prostate to the deadly gamma rays.


Maybe the CT/MRI scans pre RT will be sufficient. I think I'm going to be okay re the peeing after RT but am still nervous. At least thats an upgrade on the general fear and panic I was suffering last week 😂😱🤣

User
Posted 11 Dec 2022 at 19:07

Hi Chris,


I think 100ml of water will.weigh 100g not 100mg.


 


 


Steve

User
Posted 11 Dec 2022 at 19:31

Originally Posted by: Online Community Member


Hi Chris,


I think 100ml of water will.weigh 100g not 100mg.


 


 


Steve



Steve , quite right.


Thanks Chris 

 
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