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Urethral Stricture Treatment Cystoscopy

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User
Posted 14 Sep 2025 at 17:40

Hi.


I had RALP in Dec 2024. 


Continence has been good, but urine flow slow. Had flexible cystoscopy in June 25, showing narrowing of urethra. I've been offered "cystourethroscopy plus dilation/incision to allow inspection of upper part of urethra and bladder".


I'm anxious that any procedure might risk incontinence, although this doesn't seem a particular named risk. (I've looked at the info sheets provided by the British Association of Urological Surgeons).


But in doing nothing, I am fearful that I might at some point go into urine retention. I had this post surgery, and I've not experienced pain like it. It happened in the middle of the night and was very frightening. 


But reading other posts, it seems that once someone starts with dilation/incision, that this then becomes an ongoing process, with further dilation/incision needed, and ongoing self-catheterisation. 


I feel like I'm stuck with


- Do nothing, and live with the fear of retention


- have a procedure, and live with the risk of ongoing catheterisation. 


 I'm wondering if anyone has had dilation/incision and that sorted the flow issues? Or does everyone need some sort of ongoing intervention? 


Many thanks


Paul 

User
Posted 14 Sep 2025 at 19:10

I had a urethotomy for a stricture a year after my prostatectomy. My flow at the time was "appalling" (about 1.3 ml/sec) and so so there was a significant risk of retention which I dreaded.


Since then I have been on intermittent self-dilation, currently once every four weeks. The urologist said that I did not have to do the self-dilation but that there would be a much higher risk of recurrence if I did not do it. So far, I have gone nearly 4 years without recurrence.


There are other options for dealing with strictures. The "gold standard" is urethroplasty - this has a high success rate but is a major surgery.


In recent years another technique has been developed called optilume - this involves doing a dilation and at the same time coating the stricture with a chemical to try and prevent recurrence. The results so far have been very encouraging - e.g c70% free of reintervention after 5 years. It is a very straightforward procedure which can often be done as day surgery. It is worth looking into - the problem is that, while approved for use in the NHS, it is not yet offered in many NHS hospitals, as far as I can tell.


Good luck whichever route you decide to go down.

User
Posted 14 Sep 2025 at 19:25

If the stricture is at the bladder neck, which is most likely in the case of RALP, then there is a risk of incontinence, particularly if a bladder neck incision is required.


What you could do is to ask to be taught to do intermittent self catheterisation, and do this as often as necessary to keep the stricture open. Frequency drops over time, possibly starting as daily and dropping to every 2 weeks or less. Also, if you can fit your own catheter, you are less likely to end up waiting for hours in agony in A&E for someone else to have to do it.


There is a urology saying, once a stricture, always a stricture. Maybe not always true, but that does tend to happen.

Edited by member 14 Sep 2025 at 19:26  | Reason: Not specified

User
Posted 15 Sep 2025 at 08:58

I had a stricture which was non PCa related - it was due to scar tissue from a kidney stone some 20 years previous - and operated on in 2022 after being unable to pass water (and living with a direct bladder catheter for 3 months - that was the awful bit). 


'Luckily' the stricture was lower down and confined to less than 5mm. The op was easy, the only excruciating part was removing the urethra catheter the next day.


After the op I was pi**ing like a racehorse and 3 years hence is still good, but back to normal flow. I still sit down in the morning and ensure bladder is fully empty to prevent UTIs. The urologist recommended stopping mid flow once a day by pinching the end of the old chap, and the back pressure prevents the tube dilating again.


Now, with a stricture closer to bladder that may be a more complex dynamic? Ongoing self catheterization might be necessary if the stricture is longer or dilates quicker. 

User
Posted 16 Sep 2025 at 05:51

I developed a stricture after RARP. It's slightly outside the bladder neck. I had it dialated under GA in 2020 3 years after RARP. I request the surgeon avoided cutting if possible, so just had dilation. About a month later I was taught intermittent self catheterisation and was told it's for life. I struggled at first but got the hang of it. It started with once a week but that got difficult and now it's every 3 days. I have t o pass a size f16 first to open it up to make it easier to get a f18 in. It's been 5 years now and the stricture is increasing in length. Next review I'm going to ask about Optilume to replace the self catheterization.


Cheers
Bill

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User
Posted 14 Sep 2025 at 19:10

I had a urethotomy for a stricture a year after my prostatectomy. My flow at the time was "appalling" (about 1.3 ml/sec) and so so there was a significant risk of retention which I dreaded.


Since then I have been on intermittent self-dilation, currently once every four weeks. The urologist said that I did not have to do the self-dilation but that there would be a much higher risk of recurrence if I did not do it. So far, I have gone nearly 4 years without recurrence.


There are other options for dealing with strictures. The "gold standard" is urethroplasty - this has a high success rate but is a major surgery.


In recent years another technique has been developed called optilume - this involves doing a dilation and at the same time coating the stricture with a chemical to try and prevent recurrence. The results so far have been very encouraging - e.g c70% free of reintervention after 5 years. It is a very straightforward procedure which can often be done as day surgery. It is worth looking into - the problem is that, while approved for use in the NHS, it is not yet offered in many NHS hospitals, as far as I can tell.


Good luck whichever route you decide to go down.

User
Posted 14 Sep 2025 at 19:25

If the stricture is at the bladder neck, which is most likely in the case of RALP, then there is a risk of incontinence, particularly if a bladder neck incision is required.


What you could do is to ask to be taught to do intermittent self catheterisation, and do this as often as necessary to keep the stricture open. Frequency drops over time, possibly starting as daily and dropping to every 2 weeks or less. Also, if you can fit your own catheter, you are less likely to end up waiting for hours in agony in A&E for someone else to have to do it.


There is a urology saying, once a stricture, always a stricture. Maybe not always true, but that does tend to happen.

Edited by member 14 Sep 2025 at 19:26  | Reason: Not specified

User
Posted 15 Sep 2025 at 08:58

I had a stricture which was non PCa related - it was due to scar tissue from a kidney stone some 20 years previous - and operated on in 2022 after being unable to pass water (and living with a direct bladder catheter for 3 months - that was the awful bit). 


'Luckily' the stricture was lower down and confined to less than 5mm. The op was easy, the only excruciating part was removing the urethra catheter the next day.


After the op I was pi**ing like a racehorse and 3 years hence is still good, but back to normal flow. I still sit down in the morning and ensure bladder is fully empty to prevent UTIs. The urologist recommended stopping mid flow once a day by pinching the end of the old chap, and the back pressure prevents the tube dilating again.


Now, with a stricture closer to bladder that may be a more complex dynamic? Ongoing self catheterization might be necessary if the stricture is longer or dilates quicker. 

User
Posted 16 Sep 2025 at 05:51

I developed a stricture after RARP. It's slightly outside the bladder neck. I had it dialated under GA in 2020 3 years after RARP. I request the surgeon avoided cutting if possible, so just had dilation. About a month later I was taught intermittent self catheterisation and was told it's for life. I struggled at first but got the hang of it. It started with once a week but that got difficult and now it's every 3 days. I have t o pass a size f16 first to open it up to make it easier to get a f18 in. It's been 5 years now and the stricture is increasing in length. Next review I'm going to ask about Optilume to replace the self catheterization.


Cheers
Bill

User
Posted 16 Sep 2025 at 21:04
Many thanks to all who've shared your experience. I really appreciate you taking the time to write.

All people I've spoken to about it, seem to end up having some sort of intervention. may be I'll just have to accept that. A bit depressing, But there could be worse things.

all the best,

Paul
User
Posted 17 Sep 2025 at 10:56

Paul , you probably won't see many experiences worse than mine , but I did cope with it and doubt you will be in the same situation. 


My stricture was probably caused by the traumatic removal of the post op catheter. I like quite a few on here have also had issues with the migration of hem o Lok clips into the bladder or urethra. 


My surgeon did take a very conservative approach to treating my stricture. I was 99 percent dry four days after catheter removal and he did not want to compromise my continence. I went back into theatre or clinic on around 12 or 13 separate occasions, mostly there were for dilatations but on a couple of occasions he did cut into the scar tissue. I also did some intermittent self dilatation to keep the stricture open.  I also did some progressive ISD where I would insert a size 12 catheter, remove it and insert a 14,then repeat the process with a 16 or even 18. I did regain the continence after the procedures sometimes after a few days sometimes a bit longer.


I was due to have urethral reconstruction but unfortunately salvage RT damaged the bladder and there was no point repairing the urethra. 


It is not unheard of for it two take two or three attempts to sort the stricture. I got a bit obsessed with checking my flow but it was useful as when it got to slow I would book in for another dilatation.


Hope yours get sorted a bit quicker and easier.


Any questions just ask.


Thanks Chris 

Edited by member 17 Sep 2025 at 10:57  | Reason: Layout

 
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