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Bladder neck or urethral constriction

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User

Posted 16 May 2023 at 22:19

Does anybody have a problem with increasingly poor urine stream 16 weeks post prostatectomy ?

User

Posted 17 May 2023 at 00:09

Noel, yes I developed a stricture after robotic surgery and suffered with a slow flow. At around 14 weeks post of I went back into theatre and had a dilatation to stretch the scar tissue,at the same time they found the first of 4 surgical hem o Lok clips from the surgery.

My surgeon took a very conservative approach with the stricture, preferring to stretch it rather than cut into the tissue. I did have to have it done numerous times,2 or 3 attempts in not unheard of.

I was having my urethra stretched at 3 month intervals. My flow got down to 0.5 mls per second. Other issues came along with salvage radiation treatment so we never got to know how successful the stricture treatment was.

Glad to answers any questions.

Thanks Chris

User

Posted 17 May 2023 at 16:34

Thanks Chris

i am due to have a flow test next Thursday so will know more after that what my flow rate is. I also get discomfort when urinating, as if I can feel the scar, so maybe there is some suture material still present. I will let you know the outcome of my flow test and go from there. Did dilatation affect your continence or was that under control ?

User

Posted 17 May 2023 at 16:39

Hi Chris again!
Can you tell me please? Did the dilatation procedure happen on the same day as your flow test, or did you have t9 go back another day for that to be carried out. Just so I can be prepared next Thursday. Thanks again, and hope you are progressing better .

Cheers

Noel

User

Posted 17 May 2023 at 17:28

Noel I had my dilatations done under general anaesthetic, so also had to have a pre op before the procedure. I was 99 percent dry 4 days after catheter removal, my surgeon thinks the developing stricture helped with the continence. I did recover my continence after the procedures the recovery varied depending on whether it was a stretch or incision into the scar tissue. As someone said on here today what happens to one guy doesn't happen to all guys. I had a catheter after the dilatations or incisions. Due to an emergency I did have one dilatation without any anesthetic at all. Not in my top ten list of things to do again but I would if needed, that particular consultant is brilliant and has a sense of humour.

I also tried some self dilatation to help keep the stricture open.

I bought a urine bottle and timed how long it took me to urinate. mls divided by time gives a flow rate, e.g 300 mls in 30 seconds equals an average of 10 mls / second. The hospital machine, which at my hospital just looks like a funnel on top of a big bottle measures peak and low flows plus average. My consultant was quite impressed by the accuracy of my average flow figure.

Thanks Chris

User

Posted 17 May 2023 at 19:34

Hi Noel

I noticed reducing flow about a year after RARP and it deteriorated slowly. I was offered a dilation fairly soon but was afraid to effect my continance. Urge and frequency also increased as flow deterioted. Uro was OK with that but eventually I had to give in as my flow was down to less than 3ml/sec using the same method to measure as Chris and I was now taking over ten minutes to pee. With urge and frequency issues ten minutes to pee is difficult to manage.
Covid caused a delay and I had a dilation under GA about two and a half years post RARP. I expressed a strong preference for stretching only and no cutting. He did a ridged cystoscopy while under the GA, checked in the bladder etc then progressive dilation.
Catherter for a weekish and no incontinence after.
About 3 or 4 weeks later I was taught self catheterisation and told to do it once a week indefinitely using a size 18 catherter.
Catherterising gradually got more difficult and 3 years since dilation I have gradually increased to every 3 days and I need to use a size 16 first to get the 18 in.
I struggled at first at the learning stage but it was just a question of getting the internal relaxation right.

Regarding the flow test I had one early on and at the time flow was described as sufficient. I then just monitered myself and only discussed it at my PCa review phone calls. I can't imagine they would do a dilation at a flow test appointment without letting you know.
What ever happens all the best of luck to you

Cheers
Bill

User

Posted 17 May 2023 at 22:24

Thanks again Chris

So unlikely to get any procedure done next week, thanks.

I too have purchased a urine bottle for use when out with no toilet and for use in the car should I get caught short!

I also have started to measure my output during the day, small amounts and often in the morning and evening around meal time but not so bad during the day.

I will see wha they say next week and let you know.

Cheers

Noel

User

Posted 17 May 2023 at 22:29

Thanks Bill

For your long reply.

I too have markedly increased frequency and urgency , sometimes having to go 3-4 times in an hour just to stop the feeling of wanting to pee.
This is worst first thing in morning around breakfast time and around tea time , but in between I can go for an hour or so not wanting to go to the loo , especially when I am busy doing something physical to distract myself, such as gardening or playing tablet tenniS!

I will let you know how I get on after my urine flow test next Thursday.

Thank you for your reply , it really does help to have people with similar concerns to talk to

Cheers

Noel

User

Posted 17 May 2023 at 23:50

Noel,I don't recall having urgency or frequency issues, it might be worth doing a three day bladder diary. There are plenty on the internet,you would typically record how much and what you drink you then record how much you urinate and when and any leakage if applicable. I added my flow rate to the diary.

I will see if I can find my flow charts to see how much I was passing.

Thanks Chris

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