PCa Phase VI - Urethral Stricture

Hi Chris

I had RARP nearly 8 years ago. A while later my flow diminished and eventually got down to about 3ml/second. Urge and frequency also increased as the flow diminished. I spoke to Urology fairly early on and was offered a dilation under GA. I resisted for as long as I could because I was told that they may be able to just stretch (dilate) it or may need to cut it to open it up, at this point I'd not had cystoscopy. Eventually 3ml/sec became unmanageable so 3 years post RARP I bit the bullet and had it done. I did ask that he avoided cutting if at all possible. After the op I awoke with a catheter in which was removed after 5 days. He only dilated with no incision. I was then peeing like a horse and wished I'd got it done sooner. About 3 weeks later I had an appointment to learn self catheterisation to keep the stricture open. I did that once a week at first but it started getting difficult to get through. Now I pass a small one (size 16f) followed immediately by a larger 18f every 3 days. The peeing like a horse has diminished but flow is absolutely fine now.
Self catheterisation is no problem at all once you get the hang of it.

Good Luck

Cheers
Bill

Edited by member 19 Sep 2024 at 08:04  | Reason: Not specified

Thanks for sharing your stories guys, it is much appreciated. My flow had gone down to around 5 mL/s but 3 and 1.3 are both pretty "appalling". It does sound like there are a number of options available before you have to resort to a permanent catheter, which is reassuring. Periodic self catheterisation is a bit of a pain but it is better than putting up with five minutes of dribble every time you pee. I have some experience with self catheterisation when I was suffering intermittent retention shortly after my RP. In fact I still have the packs of 16f and 18f catheters. I will certainly ask about Optilume. At the moment I am just grateful to be experiencing a half decent flow although I am not sure how long it will last. Thanks. Chris

Hi Chris

I had a urethotomy and dilation for strictures about a year after my prostatectomy. I had a catheter for about 5 days afterwards.

The consultant clearly thought that the long term prospects of success from this alone were not high and so he advised me to undertake "intermittent self-dilation" in order to keep things going for longer. That was in November 2021 and I have (or to be more accurate my wife has) been doing this ever since. So far it seems to have worked.

There is a fairly new procedure known as Optilume which involves doing a dilation and coating the scar tissue with a chemical designed to prevent recurrence. Results with this so far have been quite successful and I am hoping that I may be able to get it one day but, as yet, it is only available in a few places on the NHS. 

Best wishes

Kevin

Chris, things sometimes progress in medical procedures. My catheter was in for two weeks after my dilatations, I think mine was was done to coincide with the twoc clinic. On the one occasion i didn't have a catheter, I went into retention the next day. I did regain my continence after each procedure, sometimes it was quicker than others. 

It is not unusual to take 2 or 3 attempts.

Hope your recovering goes well, don't forget be hydrated for your catheter removal.

Thanks Chris 

Chris, out of interest which brand of bags. Were you wearing wellies or boots. I use Bard bags and although leaks are very rare i do occasionally get a pin sized hole. Possibly caused by my wellies. I have a lock on the tap to save accidentally opening the tap.

Thanks Chris 

Chris, sounds like we both wear the bag in the same place,I have one strap above the knee but use the urisleeve to hold the bag.

Although I have been on the end of 13 urethral catheter removals not sure I would have the courage to do it myself, might be worth chasing. My attempt to self catheterization at the hospital was a complete failure, they just sent me home with the kit and said try it at home.  Would you have the right equipment to deflate the balloon.  On one occasion I had a urethral and suprapubic catheter at the same time for a month.

Not sure if it was you I posted too about self catheterization, I will find it and add to this.

Thanks Chris 

Added

As regards the self dilatations the main advice is relax and be gentle. I used to do mine in the shower in the morning just after urinating. You might want to ask the hospital for a variety of catheters. I got on best with a coude tip catheter, they have a curved end and a slight rotation of the catheter will  usually find the passage. Be very gentle, it is very easy to do damage by pushing too hard into a false passage. I found that although there was a bit of discomfort in the penis there was no feeling of pain in  the urethra. If a catheter gets stuck on the way out ,then relax, wait a while, relax a bit more and then gently remove the catheter. Only use lubricants designed for catheter use. Hope all goes well. I also did some progressive dilatation, starting with a 12 , then removing it and inserting a 14, or using a 14 and then a 16. 

Edited by member 23 Jan 2025 at 22:35  | Reason: Not specified

Chris, One of my old school urology nurses told me exactly the same. It is a pity she was not on duty when my RARP catheter got stuck, I may have avoided my stricture. There are other causes, urine leaking into the joint, my surgeon has checked that the joint was water tight. Another cause is over tight stitches , back in my day the robots didn't have tactile feedback, so the surgeons couldn't feel how tight stitches were.

Good luck in whatever course you take.

Thanks Chris

Edited by member 24 Jan 2025 at 15:50  | Reason: Not specified