Post green laser surgery, I have a persistant and recurring bladder neck stricture. I have had four follow-up surgeries to remover the scar tissue in the past year, but each time the stricture grows back. Currently, I am self-cathetering twice a day and the Urologist has recommended in-office dilation every six weeks to temporarily keep me out of the OR. This is very painfull and bloody and not a satisfactury outcome as far as I'm concerned. My question; where is the place to go to get the best leading edge treatment for bladder neck strictures?
Yes. In May, I had surgery at MUSC in Charleston, SC, by Dr. Eric Rovner. He performed a proceedure called a Y-V Plasty which involves sewing bladder tissue into the bladder neck area to cover about half the circumfrance. This is vascular tissue that prevents the scar tissue from reoccurring in that area. I went back for a follow up in October and he found that some scarring had occurred but had not closed the bladder neck. Proactively, he decided to remove the scar tissue, so in November he did a cold knife TURBNC. He found that the scar tissue was just a very thin vail and was easlily removed with no bleeding post op. I am now doing daily self caths with a 20Fr catheter until I return for follow up in February. The only difficulty I have had so far are a couple of cases of urinary track infections which are treated with antibiotics. I am confident I am now finally on a path to complete recovery from the BNC issue...a process that has taken me three years.
You might want to inquire about putting a stent in. I had a TURP and resection of the bladderneck in 1995. I had problems urinating and it was found that I had a obstruction of the bladderneck. The TURP went well, but it was later discovered that I have a neurogenic bladder. As a result I used to self cath from 1996 till 2008. 2008 I ended up with a fistula and I have had a catheter in since.
From 1996 till about 2003 I used to self cath once to twice a day. After having had another urodynamics test in 2003, it was recommended that I'd increase the self cath. While I was doing the catheterization more frequently, I was cutting the infection rate.
I do have Cipro on hand in case I know that I'm coming down with an infection.
Increasing the frequency of catheterization might cut the infection rate.
Having a stent put in might also prevent the stricture from re occuring.
Thank you for your suggestion of using a stent. I have discusssed this with several urologists including my Dr at MUSC and they all have strongly recommended against it. I believe the Y-V Plasty is working and I just need to get past the daily cathing over the next two months.
I don't know if the following will help but I has helped me at times with self cathing. I have used both 2% and 5% xylocaine jelly and cream. It does numb the urethra, however since you experience pain from dialation you might want to bring this to the urologist's attention. Having the area inflamed from dialation could cause burning near the area of dialation. I have used it because of having had a urethral catheter in for about a year before they placed a suprapubic. In my case there was pain near the prostate fistula area and the urinary meatus where the catheter was irritating the glans. For me there was a bit of burning at first, but then the numbing effect took place and I was able to have some relief.
From having self cath. since 1996, I at times used it to get some relief. It might work for you but discuss it with the urologist first. You don't want to end up with a part of your body burning that you can't get access to. I just recently did something simmilar and was stupid enough not to act sooner.
With the suprapubica catheter in I get bladder spasms once in a while. When this takes place I have urnine leakage from the penis. To deal with this I have been using condom catheters. Once I'm ready to replace the condom catheter, I'm left with the glue from the apliance that is difficult and at times painful to get off my penis. I had gotten some pads that I can use to disolve the glue from the penile shaft. I had thought that it was simmilar as the skin barrier that I use. I thought that it would take of the skin barrier as well. I cleaned my penis with it, retracted my foreskin to get access to the glans. At the time of use, it seemed to work well and due to neurological problems I did not rigth away notice any burning. Thinking that things were going to be fine, I prepared the new condom catheter unroled it on my penis and glued it back on. Still thinking things were fine I went to bed. Several hours later I woke up to nice some mild burning. Not thinking too much about it, I tried to go back to sleep. I was awake most of the night and in the morning I decided to take the catheter back off again and I saw the damage. The outer layer of skin of my glans was coming off in pieces, and I was left with a very red, painful irritated glans. I still have this problem and am treating it with a steroid cream.
I don't want you doing something simmilar, so you can phone your urologist and ask about the Xylocaine cream or jelly.
Using a lot of lubrication on the catheter will make things easier as well.
I hope that things will go well for you and that you may stop the self cathing soon. In my case the urologist thinks that I have caused the fistula between my prostate and rectum as a result of self cathing.
Having had to do this since 1996, I must say that I had gotten used to it and things had become much easier then the first few times.
I think that the urologists want to use a stent as their last resource. Once a stent is placed it can cause scar tissue in the area of the stent. I guess they have your best interest in mind.
I've also read about using stents and the difficulty they can cause. But most of the literature is basically about a permanent stent called the Urolume. I know you saw Tom2244's (friend of mine) post about the Spanner which is a TEMPORARY stent. Because it's pretty new (FDA approved in 2006) most urologists don't know about it and they don't differentiate between permanent and temporary stents. The temporary stent is basically a short Foley, just long enough to fit between your bladder neck and your sphincter - so you can pee normally and you don't have anything hanging outside your body. You and Tom did basically the same thing - kept your urethra open for an extended period of time to allow the tissue to heal without sealing the bladder neck closed. You are using daily self-cathing. Tom used the Spanner. Am I making sense? Tom didn't have to do anything daily - after a coldknife, the Spanner stayed in for 90 days, and then replaced with another Spanner for 90 days. Since his last Spanner was taken out, he's been urinating on his own, without any devices for over 9 MONTHS now. Sure wish you well with your appointment in February. Praying for you that there has not been any more scar tissue regrowth. But if there has - talk to Tom some more.
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