Re: Urethral Stricture

Posted By HFHS M.D.-MS on April 02, 1998 at 08:15:59:

In Reply to: Urethral Stricture posted by JD on March 22, 1998 at 14:04:41:






I have been diagnosied with a Urethral Stricture.  Symptoms include frequent urination, with a very small stream of urine.
The doctor investigated with a cytoscope ( perhaps not the correct name, it was a device with a small fiber optic sensor on the end).  He found a restriction that was almost too small to pass the instrument through and then dialated the urethra at that point.
I was thrilled at the results !! However about 6 weeks later it constricted again.
I was then dialated and given an injection in the stricture.
For follow up treatment I was instructed to catherize (wrong word, I am sure) myself on a regular basis with a #18 catheter.  I have been doing this on a 7 to 10 day basis, with good results for over 6 months.
On two occasions the catheter has become blocked, even after I have attempted to force it.  The tip of the catheter would have blood on it after removal.  The next day the catheter would pass smoothly.  (i attempted the next day because it takes several days to get into see a urologist).
Also I tend to drip urine for about a day after self-catherization.
My Question:
Is this a valid form of treatment for urethral strictures?
Any better ?
Will the 7-10 day interval stay the same ?
Have I hurt my cause by attemoting to dialate the stricture myself ?
thanks,
JD





Dear JD
Thanks for your questions.
This is a common therapy for recurrent urethral strictures, and if effective is the only way to avoid surgery. The literature has recently taught  us that once recurrent strictures fail a single dilation or incision ( with  laser or cold knife through the scope), the best surgery that has good long-term results is an open urethroplasty  ( an open surgery in which the diseased segment of urethra is removed and fresh ends are reconnected in one or two separate operations).  The number of open urethroplasty operations depends on how long the area of scar is in the urethra.  You may also  have to have a temporary catheter thought the skin into the bladder.  Most patient are happy with the results however the repair can re- scar.  This operation is more of  an undertaking than looking in with a lighted telescope and should not be taken lightly. If you are able to successfully manage your stricture disease with self dilation and are satisfied with the results, I would go with that  treatment for now. On the other hand, some believe that repair is inevitable and planning the open repair electively gives more peace of mind than waiting till you are in trouble and cant pass your catheter and require urgent medical care. If you have difficulty passing the catheter every ten days or so try decreasing the time between caths ( say every 7 days or less ).  This will give the urethra less time to narrow back  down. While there is more trauma done when you have difficulty  passing  the catheter,  this is probably the solution ( dilation) your urologist would do in the same situation.    Dont worry about passing the catheter too often, other than the discomfort,  most people with bladder paralysis pass the catheter four times a day.
More individualized care is available in person  at the Henry Ford Hospital and its urban campuses. Please call  (1 800 653 6568) if interested in setting up an appointment to meet with us in person. . We can also arrange local accommodations through this number if this is your need. Please bring any physicians notes and lab test results that you may be able to obtain. These will help us greatly. This information is provided for general medical education purposes only.  Please consult your physician for diagnostic and treatment options pertaining to your specific medical condition. Hope this has helped.
Very Sincerely Yours;
HFHS-M.D. MS
* Keyword: urethral strictures, self dilation, open urethroplasty, incision of stricture, DVIU