Is dilation after surgery necessary?

[Brad__0]

Posted by Brad on April 24, 1999 at 11:02:00
I recently had surgery (cystoscopy) to cut open my urethral stricture which was followed by 10 days of wearing a catheter.  My doctor said that the surgery was much more difficult than he expected.  Normally, they use a guide to find their way during the surgery but, for some reason, he had to cut "blindly" because of a problem in following the guide.  Nevertheless, except for excrutiating pain after urination a few times (doc says the symptoms sounded like spasms) and the pain of night time erections while wearing the catheter (dried blood on the tube), it seems the operation accomplished what it was intened to accomplish.
However, the follow-up treatment shocked me and I've still not recovered from it totally.  I had no idea what dilation was before it happened to me and it was extremely painful... so much so that I cried out and doubled up on the table.  Probably didn't help matters for the rest of the patients that day either.  
Anyway, the second dilation wasn't as bad but I had them sedate me.  I'm scheduled for two more a month a part without sedation.  Is this necessary????????  I understand the obective is to "train" the tissue to scar in a more open shape and not close back.  However, my problem has gone from one between my legs to one between my ears and I'm still having a hard time dealing with this.  I can tell that the urethra walls have hardened as a result of scarring, I guess, and I am still having some pain in having erections which I'm assuming will go away once the tramas discontinue.
If dilation is not proven to be effective as a sole treatment for a urethral stricture, is it an effective procedure post operatively after the cystoscopy surgery?  I certainly don't want any more of these than I absolutely have to have but, if it reduces the likelihood of a second surgery, I'll do it.

Posted by HFHS M.D.-BE on April 25, 1999 at 22:03:47
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Dear Brad,
The procedure you have described is DVIU, or Direct Vision Internal Urethrotomy.  This is the most common initial approach to treatment of urethral stricture.  However, there is a rather high--up to 80%--rate of stricture reformation associated with DVIU.  The procedure of choice in the case of failure of DVIU, especially in younger men, is urethroplasty.  This is a formal repair of the urethra by making an incision (usually in the perineum), finding the point of stricture,  cutting the narrow part out, and reconnecting the urethra.  This often heals with good results and solves the problem of continued scarring--it is up to 95% effective.  The fact that you have required dilation following DVIU would suggest that the procedure was not successful in alleviating your stricture.  Your option(s) would be to have a repeat DVIU, or consider urethroplasty.  Pain during dilation is very common,  and most patients request some degree of sedation to tolerate the procedure.  Painful erection would not be surprising  for you, given that you have had repeated procedures performed on the urethra.  The more dilation you undergo, the more scarring you may be likely to incur.  Further dilation could be counterproductive.  Your best bet is to follow up with a urologist who can evaluate you formally and help you determine the proper course of treatment.  
This information is provided for general medical educational purposes only.  Please consult your physician for diagnostic and treatment options pertaining to your specific medical condition.  More individualized care is available at the Henry Ford Hospital and its satellites (1 800 653-6568).
Sincerely,
HFHS M.D.-BE
*keyword: DVIU/stricture