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Urethral stricture options in active 41yo male
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Urethral stricture options in active 41yo male

i am a 41yo wm. discomfort during urination started when I was an adolescent and has been there on and off ever since. was diagnosed in my 20s with chronic prostatitis and have taken antibiotics for that a couple time in my 20s and 30s. the last few years my urine stream has gotten narrower but i could live with it. for the past 6-8 months i've started having more pain at the tip when urinating and some cramping in the pelvis.
i had a few dribbles of blood-stained urine one day about a month ago so i went to my family practitioner 2 days later. he did a urinalysis which showed no blood, but ordered a pelvic CT. they only did a non-contrast because the medical imaging people were not aware of my allergy to shellfish. the CT showed nothing in the kidneys but my bladder wall was thickened and there is some prostate calcification however, the radiologist and urologist didn't identify those as anything pathogenic.
because there was some blood the urologist set up a cystoscopy to take a look but hit a stricture in my urethra and couldn't get the scope through. he immediately set me up for a DVIU to repair the stricture, which will take place in a few weeks.
questions:
1) should i ask for any more testing prior to this procedure (e.g., urethrogram to show the length & location of the stricture, or is it standard to order the DVIU without it?
2) given the 40-50% success rate of repair with DVIU, if it's a size or location not typically responsive to DVIU, is it ever prudent in any case to skip right to urethroplasty? i lead an active physical life and would prefer not to have ongoing, multiple procedures and would be especially averse to self-catheterization
3) given that my urethra is currently strictured, but functional (i had about 1 tbsp of urinary retention prior to the cystoscopy), is there any risk that post-DVIU stricture recurrence could result in acute urinary retention?
4) any other feedback or comments would be welcome as well
Thanks!
Avatar_dr_f_tn
Hi,
As mentioned from the other post, complication of Direct vision internal urethrotomy (DVIU) procedure such as abscess or damage to urethra, recurrent stricture, dysuria, erectile dysfunction, bleeding, injury to surrounding tissue and reaction to anesthesia may occur. And prior to the procedure, the attending physician usually conducts a complete physical examination; order imaging, blood, and urine tests; and discuss the anesthesia to be used.  There are many factors to consider such as your medical history, age, how well you tolerate the procedure, the management plan of your doctor that needs to be discussed before the procedure. And some of the questions you posted may only be answered by the attending physician. Do keep us posted how it goes. Best regards. .
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