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Urethroplasty
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Urethroplasty

Hi,
I have a urethral stricture of about 4-5 centimeter long.
Doctors suggested me a Urethroplasty where they would replace tissue from my mouth.
Since i have never had any surgery done, i am worried about the risk involved and the success rate (especially in my case as they told me my stricuture is relatively longer).
Any suggestions.
Thanks
Raj
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Avatar_dr_f_tn
Hi Raj,
A urethroplasty is an operation for the repair of an injury or a defect in the walls of the urethra. The method you are pertaining to utilizes tissue transfer or free graft technique. In this method, tissue is grafted from bladder epithelium, or buccal mucosa and is used to enlarge the strictured  segment of the urethra. Urethroplasty is performed under general anesthesia. Risks of Urethroplasty include: recurrence of urethral stricture, infection, fistula,  or even allergic reaction to anesthesia. Usually you meet with your doctors prior to the surgery to discuss the procedure in detail to evaluate all the benefits and risks of the procedure.  The success rate reported for Urethroplasty to treat urethral stricture is 70 - 80%. This link may be helpful: http://www.medsolution.com/surgery_urogen-urethroplasty.asp

Take care and keep us posted.
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Avatar_m_tn
Hi Raj,  I had urethroplasty surgery, on 2006.  I had several strictures, between the bulbous urethra, and the meatus.  I had a two stage surgery to fix the problem.  Unfortunately, since I was circumcised, I had no readily available donor tissue.  They used buccal mucosa tissue, to rebuild my urethra.  The first stage was to remove the damaged tissue, and graft in the buccal tissue, and left these repaired areas splayed open, to heal.  The Dr. also temporarily rerouted the exit point of the urethra, to the area beneath the scrotum.  I had to sit down to urinate, for 6 months.  When the second stage of the surgery was performed, they hooked everything back up, like normal, and rolled the repaired urethral areas around a catheter, and stitched everything back together.  Since I had a stricture at the meatus, that is the only area where I still have any issues.  The exit point is underneath the head of the penis.  During the recovery time, I had a couple stitches pull out in this area, so my exit point is about an inch back from the tip of the penis.  I must say I am happy with most of the results.  Not so happy that those stitches pulled out.  My only major issue now is the lack of sensation in the penis, during sex.  I take Cialis to help maintain an erection, but due to the amount of cutting, and stitching done, I only have sensitivity in 60 - 70% of the penis.  This leads to not always reaching ejaculation.  I just thought I would pass this info along.  Good luck with your procedure.
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Avatar_m_tn
I am going through this surgery on March 05, 2010.  What is the recovery process like?  How long did you have your cathader on your first stage?  How long before you were back to normal, I know you have to urinate sitting down for awhile.  Let me know, thanks  Raul
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Avatar_m_tn
Hello, I am getting a urethroplasty  next month and I was just wondering how the recovery process is. I am aware that I will have two catheters after the surgery for about 3 weeks and I was wondering if there will be any painful sensations to urinate or bladder spasms during the  recovery process. Thank you
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Avatar_m_tn
First, I'm laying in bed typing this 5 weeks after having urethrorplasty surgery.  I had been dealing with a sticture for 26 years, I'm not sure what caused the initial stricture.  After dealing with the issue for a couple of years taking drugs for kidney infections the narrowing became so bad that I went to see a specialist who immediately scheduled me for sugery.  Now I understand that the type of surgery I had may have caused more problems than it solved.  The surgery was done under general anesthesia and consisted of a scope with some time of blades to cut the stricture.  No catheter was installed, in fact I awakened to find a nurse telling me I couldn't go home until I had urinated.  Talking about painful, after several bags of IV fluids I couldn't hold out amy longer.  I finally relented and with assistance went into the restroom where more blood than I had ever imagined came forth along with what appeared to be major parts of my body.

I was better for about 4 years before I admitted to myself that it was happening again.  This time I had  some type a balloon procedure that hurt like heck but not like before.  The results only lasted for about a year, this started a downward spiral for the next several years.   At one point I was using a ballon catheter daily, inserting it then inflating it with a syringe full of water to inflate and open up the stricture.  I did this for a couple of years, needless to say even as carefull as I was I was plagued with multiple infections.  The catheter was placed in a pitcher filled with vinegar something my doctor ordered.  The catheter had to be reused and laste almost a year before it spung a leak.  I was instructed to use some type of persription salve which coated the catheter along with a small amount of lubricating jelly to help with insertion.

As time went along it became more and more difficult to insert and use the catheter, I was having to force it in with mutiple attemps to break through an ever increasingly tough and longer stricture.  Finally I was unable to complete the task and went in to another doctor, by this time I'd moved to another part of the country.  The new doctor inserted a very small metal rod then inserted increasing larger rods to open the stricture.  This was done in his office with only a small amount of lidocaine jelly before the procedure.  

Last year, my local specialist told me I needed to have a urethroplasty.  What?  I had heard of the procedure and can honestky say it scared the crap out of me.  I finally agreed, and went to see the specialist my specialist recommended for the procedure.

Now, here's the story.  I saw Dr. ????? in the Dallas area, was scoped the same day and scheduled for two separate procedures.  The first was done 3 days after the initial consultation where a suprapubic catheter was inserted through my pelvis into my bladder.  This is something I'd never heard of and knew nothing about.  It was installed for almost 6 weeks, these were some of the most difficult weeks of my life.  The pain was incredible, I felt as if I was being continuously stung by a wasp.  That never relented amd physically as well as mentally wore me down.

The surgery was done 5 weeks ago, they removed the suprapubic catheter during the surgery which I was greatfull for.  I had buccal muccosa removed as well as foreskin to make up the new urethra area.  The surgery lasted about 3 hours and recovery room time was an hour or so.  

First impressions after waking up, what the heck did they do to my mouth?  My tongue moved across what felt like a gaping hole inside my left cheek, that was awful and still is an issue.  I can feel the scar and continuously bite it accidentally.   The surgery gave me a large scar on a large section of my scrotum along with the accompamying stitches that fell off after about 3 weeks.  The scars and 2 separate areas of my penis has me worried as it appears that this will cause a problem with errections in the future.  

Pain, yes, yes nad heck yes.  This is dibilitating to the point where you are mentally and physically tired and sick and wonder if this is worth going through.  I go in tomorrow to have the catheter inserted in my penis tomorrow.  I hope that it will help ease  some of the pain but, the pain that will accompany the removal is worrisome to the point that I am very intimidated and honestly afraid to go.  

I guess I'm on the road to recovery, but that road seems to be very long and mostly uphill with more bumps than I'd ever imagined.  So far this is my true story.  I will post again to fill in my final anaylisis of the success or failure of the procedure.  

I hope this helps someone else...
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Avatar_f_tn
I am sorry that you had so much difficulty.  My history is poetry much the same as yours.  About 6 weeks ago I finally had Urethroplasty done.  Sure, it was difficult and scary.  The hardest part for me was having a catheter in for 3 weeks and being basically immobile.  It is amazing how slow time can go.  But, I had plenty of time to read posts like yours that scared the crap out of me.  I can now urinate great with no pain, no bleeding and my cheek is returning to normal.  My urologist told me after the surgery that he had only done 6 of these before.  Will it last?  Who knows, but so far it seems more successful than the other surgeries.  And I later found out that the other surgeries had zero percent chance of success.  I wasn't told what to expect following surgery, so the first week really surprised and concerned me.  But now that things have returned to normal (even the scar is disappearing) I am good with it.  I would absolutely have the surgery again if I had to.  Please don't scare everyone to death.  The success of this surgery is very dependant on the surgeon, taking appropriate care and precautions post-op, and having faith in God.
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Avatar_n_tn
DO NOT WAIT!!!!   GET IT DONE!!!!    I waited to long to have the PROPER repair done and because of that and the 6 failed attempts at other repair methods, the urethral tissue is not healthy and after 3 stages of repair over nearly 18 months it was decided that the stricture (scar tissue) and the massive infections caused over the years by the stricture and repair attempts along with a build up of resistance to antibiotics WOULD RETURN. Even after the grafts and catheters (6 weeks each time) the doctor offered me a choice. Either I go through several more graft surgery's( I only have one side of my mouth left to get the tissue from) or leave it as is with the exit behind my scrotum (sit to pee the rest of my life).  I left well enough alone and decided against more surgery. The good thing is that I have not had an infection since stage one (the graft)
    Another severe problem caused by waiting to long was that in Nov of 08 while suffering from a severe bladder infection I injured my back.  The infection went systemic and settled at the injury point of my back.  L2-L5. Two of the disks were completely destroyed and the third went about 11 months later. So before major Urethroplasty I spent 8 weeks at home in bed in a turtle shell back brace with a pic line taking massive doses of antibiotics (3 kinds) I V, 4 times a day 2 hours each time.  Once the infection was under control  I continued wearing the brace for about 4 months as my back self fused.   Then came the 3 stages of Urethroplasty.1:new opening and graft from my mouth, catheter from the new opening for 6 weeks along with stuffing Xeroform gauze into splayed opening in my penis at the graft site till it was nearly closed 4 to 5 months. 2: close the graft site and the new opening, catheter in the normal way 6 weeks then 6 months self cathing 2 times a day then the Dr scoped me and dropped the bad news that it was not working, I already knew it because the only way I could urinate was by cathing myself and I could feel the scar tissue growing again. 3: reopen the exit behind my scrotum , cath for 3 weeks and exit left.
   After all this I then had to under go having my back fused with some titanium hardware which I am nearly recovered from and ready to go back to work.  I have only been off disabled  since Nov 08  all of it due to NOT having the Urethroplasty done before the tissue became UNHEALTHY, as the Dr said, and unable to finish the repair.
   Was there pain involved? ABSOLUTELY, discomfort? ABSOLUTELY, mental stress? More like distress.
    It has been 6 months since stage 3 and about 2 months since the back surgery. The graft site is still very tender to the touch  and yes I am shorter and have lost sensation to about 60% of my penis , I have yet to experience intercourse and frankly I am extremely worried about it.
    All of this was the direct result of waiting too long to get the Buccal Mucosa Urethroplasty done. Had I not waited my back would not have gotten infected and almost destroyed , I would in all likelihood still be employed at over 4 times what disability insurance pays and the bill collectors would not be harassing me daily.
   The morale of my tail is IF YOU NEED A URETHROPLASTY GET IT DONE DO NOT HESITATE BECAUSE YOU WILL BE MAKING IT WORSE BY PUTTING IT OFF.!
                                                                                             JCK
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Avatar_m_tn
I was diagnosed with a severe stricture in December 2011 - blockage was at 90% at the beginning of December. Due to increased discomfort, and inability to urinate, I underwent the insertion of a supra pubic tube.  After that procedure I met with the surgeon in the area who performs the bucal urethroplasties.  I found out at that appointment in late December that the stricture blockage was up to 98%.  I underwent the actual procedure on January 20, 2012 and I am still in the recovery process.

Awaking after surgery I was actually a bit surprised at the lack of overall pain.  My surgeon's policy is a 3 day hospital stay, for which I was grateful so that I could recover and get the necessary medicines.  I was able to go for 6 hours between doses of percocet, and did not need any IV morphine.  I was also given a bladder spasm prevention medication every day, an antibiotic, and valium.  I was told that the valium was to make sleep easier so that discomfort would not wake me up.

I was sent home with pain medicine, antibiotic, valium, and the bladder spasm medicine.  I also have the two catheters that the surgeon told me I would have - a newly replaced suprapubic tube, and a regular foley catheter from the penis.  The foley is blocked and is being used as a wick for any internal bleeding from the procedure (which stopped after about a week).  I am using the supra tube just as I was before the actual procedure.  Pain after a week was manageable with only tylenol - and that is largely for the mouth.  I go back in about 10 days for removal of the foley and the blocking of the supra tube.  If everything is working after that step, the supratube will be removed about a week later.

I can honestly say that while I am uncomfortable (let's face it, an indwelling catheter in the penis is going to be uncomfortable), the pain is not overall that bad.

Talk to your doctor, but don't be put off by the possibility of pain - the other "solutions" for strictures are just as painful, and have much, much lower success rates.
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Avatar_m_tn
It has now been 24 days since my procedure - the catheter came out yesterday, and the xrays showed a completed repair.  The surgeon left it up to me for how long I was to leave the supra tube in and showed me how to remove it.  I removed the tube this morning with no problems.  How to I describe the results?  Miraculous.  I have never had this good of a urinary flow in my life, at least not that I remember.  There is still a bit of burning(as is expected from the long term catheter), but it is bearable.  Bladder control is normal.  Next up is a three-month urinalysis and post-op appointment.  I won't be scoped again until the 6-month mark to protect against possibly damaging the repair.  Many thanks to Dr McCammon at Urology of Virginia and Eastern Virginia Medical School.
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Avatar_n_tn
Hi Kevin, Hope your doing good.,
Thank you for the Drs. information that is really helpful. I am also facing the same issue and My Dr. suggested Urethroplasty surgery, but was not sure whether I should get it done with him or look for a Dr. who has done these kind of operations before. This Dr. was honest with me and he said I have never done this operation before, but its not a critical and I know how to do the surgery. So I am not really sure.  Small clarification on surgery, I hope you had a Urethroplasty where they would replace tissue from my mouth.
If you don't mind can your share your contact details so that I can talk to you in person.
Thank you,
Ravipodduturi
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Avatar_m_tn
Ravi,

Sorry for the delay, I hadn't checked in for awhile, and I just noticed your post.  You can reach me at ***@****.

I did have a graft from my mouth for the repair - things are going great.
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Avatar_m_tn
Hi,
I had The same urethroplasty procedure 6 weeks ago and one of the main reasons was the doctor had done this proceedure 100's of times.
Get a doctor who has done it before. I was in Surgery for 6 hours and went home the next day. While I had both the cath's (SP and foley) for two weeks it is so worth it .
One comment above everyone is different I had the surgery April 6th 2012 but had a superpubic installed in feb. in order to measure the strictures length.
I can tell you the tube is a pain in the but the leg bag, tape, etc. I went on vacation to Jamaica with it, traveled for work with it, etc. It didn't hurt for me it was a logistical pain more then anything.
My doctor has limited any lifting activity for 6 weeks so now I am really happy since I can golf, work outside,etc now.. Also no sex including by yourself for 8 weeks that one is tough but getting through it.
As for the results I have had not tubes in me for a couple weeks now!!! my Flow is awsome (plenty of hydrating water keep it flushed out)
I have had stricture issues for 25 years only had it dilated twice in that period which limited scar growth, I can tell you I wish I had this done from the start and had it behind me but it is nearly there now.
Would I do it again in a second, Is it a few tough months yes, would i use experienced doctor yes even if I had to fly, or drive, or move to a spot for the duration of the process I would recommend my doctor to anyone, She is awesome
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Avatar_m_tn
Got operation on april 10 2012. It has been a complete nightmare.  I got a post op infection that ate half the skin off my penis . I have been back in the hospital 2 times since the operation, had 2 super pubic caths put in and removed.  I have a fistula. I have been in nonstop pain since the operation, sometimes excruciating. All started when I got home within 12 hours pain, pus and fever.  Called doctors office and was told "this was normal".  This went on for 5 days until I begged to see doc .  ( I know people are saying, why didn't you go to the emergency room, easy, doc's office never said to and I really didn't know how bad I was) When I went to see him I was told how bad the infection was. The doc took samples with some sterile q-tips and said " you need to be in the hospital with IV antibiotics." I went to Hospital got to admitting and saw someone right away.  I then SAT in admitting for 2 hours.  I called my wife who had left me at the hospital. she called the doctors office, which was closed by then.  As I was screaming on the phone to my wife as to how scared I was and that I wanted to come home a guard came up to me and said , hey I think they got you a room.... Yes I got a room.... then 4 hours later, no IV ,no pain pills, bathroom had a shower , no curtain, no knob to turn on water and the sink in bathroom leaked.  There wasn't even a patient phone in the room they had to bring me one. They did have a guy at about 45 minutes in hook up the base stuff for an IV but no IV.  YES I DID COMPLAIN.  So after 4 hours of non treatment I called a cab. the on call Doc called me on the phone in my room basically to say I was leaving AMA, I said, what AMA I haven't been treated in 6 hours.
Cost me 105 to go about 45 miles, one way.  
I stayed home just long enough to sober up from the pain pills I was lucky enough to have brought with me when I had first seen the doctor.  No it was not enough to kill the pain but I could be arrested for DUI, so I waited ( my wife cannot drive stick)
At 5 am, 1 week after my primary operation, I drove myself to a closer hospital and went to emergency room( No, I should NOT have driven but I felt I had no choice and remember, on drugs, not thinking clearly).  Not even 2 hours later I was hooked up to 2 very strong antibiotics ( one was Zosyn) and they had me in a room no more than 2 hours after that.  They did explain a lack of space but were not sending me away.   After 4 more days in hospital in constant pain,unable to sleep for more than 3 hours I eventually got well enough to be sent home.  They thought I may have MERSA. The CDC got involved and all the while i kept calling my doctor who did the operation and begged him " do not abandon me".
Still in lots of pain went to see another doc from  the operation.  He is being sympathetic but is telling me 25% get infections from this operation.  Tells me if i pee from hole ( oh I forgot to mention the hole in the base of my penis that "magiclly "appeared ) operation  is a failure. To be safe, as I was already getting 2 different stories from my doctor who was absent and this guy. I recorded the appointment on my phone.
Another 2 weeks go by still lots of pain.  Went to xray contrast test... Yup got a hole not takling out cath... I have been complaining it was getting harder to hold back from pissing past the cath.  I also said I was not even getting close to an empty bladder.  
Went to see original doctor who did operation, his FIRST QUESTION WAS
"why did you leave the hospital?"
He gave me  completely different answers than the first doctor( again I recorded the visit). He says infections rarely happen.
I asked why was I released from the hospital so soon after the operation. He said that's what we do.  
He stated I needed a super pubic cath put in and the one in my penis was too small.
I would not agree to the operation as I was VERY drugged up from pain killers and I said I needed to talk it over with my wife.  But he kept pushing, I would not back down.
I got home and called my Insurance company cause i didn't know who else to call.  I told them what you have read here but with more detail.  They said DO NOT RETURN TO THAT PROVIDER.  They said THEY were filing a formal complaint.  They have since sent me to as hopsital 100+ miles away ( no place around here does the Urethroplasty.
That Night I sucked 950 ML of urine out thru my cath hole with an irrigation sringe.  
Even my old Uro doc had no clue to the procedure.  I have learned that certian tests and stuff were not done either at all or properly before I even got the operation.  I know some doctors do things differently but this was well beyond different. Heres one for ya to think about ... When I got to the new Doctors office I was all but drugged on the spot to have a super pubic cath put in... My other doc the one who actually wanted to do the operation wanted to wait another 2 days.  These folks thought different.
I was never checked for STD's Pre OP  infections BOTH contrast tests were not done.  and on and on and on.  At the 8 week mark I have a 14f super pubic in I have an appointment on the 14th to see if they can do the proper diagnostic test on me to see how long, how bad and so on.  I do believe I am a rare example and please if you need an operation get checked out  and get it done. I remember reading the first few posts on this site about this and saying " that poor ******* hope it don't happen to me" well it did and worse.   Please excuse any errors with spelling and grammar this is a very upsetting issue for me and I do my best.
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Avatar_m_tn
My goodness that sounds horrible. My name is tim and i just had my urethroplasy done 7 days ago and i am in so much pain. Im worried because my testicles are still very swollen and darkish purple in color. I was wondering if this is to be expected.
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Avatar_m_tn
Im so sorry for those who had bad experiences. I hope it all works out for you. Mine (so far) has been not too bad! I spent so much time worrying about this op and looking at these forums that I thought I would shed some light on the recovery period that I experienced, and what to expect/not as its still fresh in my mind.

First of all, im in London, UK. I developed a stricture in the Bulbar Urethra about 7 years ago. In 2008 I had a Urethrotomy done, which totally f**ked up! Basically after 3 days of having a catheter in they took it out and just shoveled me out of the hospital. I urinated fine the first time, but the second time I felt a twinge in my urethra and then came about a pint of blood from my meatus! The scab from the urethrotomy must have just fell off! Anyway, this scarred me and for years I put off having the Urethoplasty done (as the stricture came back even worse than before the urethrotomy) because I was terrified of going through that again!

About half a year ago, my stricture almost blocked up completely and i thought thats it im going for it. I spoke to the surgeon before hand and he reasured me that what I experienced 6 years ago would not happen. He explained the op has a 95% success rate and even the 5% that fail is a very restricted catagory with 70% of the 'failures' being infection which can be treated simply with antibiotics. I went for it and agreed to having the op done.

I had the urethroplasty 2 weeks ago. I underwent a Buccal graft surgery with the stricture in the bulbar urethra. The op was done through via the perinium. When you first wake up there is no pain at all. Your mouth feels realy odd and talking is a bit strange (expect to dribble a bit!). Once the heavy weight pain killers subside, expect to feel quite a bit of discomfort. Its no really painful its more like a bad bruise, a constant dull ache. I stayed in the hospital for 1 night on IV antibiotics and some other painkillers which helped alot. I felt very drowsy and weak but thats because  my body dosnt like General Aneasthetic very much! The surgeon came and spoke to me to tell me the op was a success and was technically a simple procedure for him. He said that I was the 500th urethroplasty he had done and not to worry too much. He explained not to move around for 5 days or so and have someone nurse me for 5 days effectively.

At home, my girlfriend looked after me and insisted I stayed bed ridden for 5 days. She did all the cooking and brought me drinks and helped me shower etc. She really was amazing and I suggest that you find someone to do this for you. Really you should be bed ridden for 5 days AT LEAST! If you move around too much the graft can not stick as well. I dont mean stay in the same position for 5 days, just dont walk to the shops, do the cooking and cleaning or anything like that.

For the first 7 days expect the following, all of which are totally normal and expected! Swelling of the balls, pain in the perinium, discomfort from the catheter and general tiredness / dizzyness when you get up. The one thing that scared me the most and got me Dr. Googling was erections at night. Oh my god, they are horrible! Bearable but just so uncomfortable. After erections I would wake up and have a slightly bloody sticky discharge coming from the meatus (your pee hole!). Again, this would freak me out because i thought that the blood meant the graft wasnt healing. NOT THE CASE! This is totally normal and your bodys reaction to having a plastic tube sitting in your ureathra and is known as penile mucus (nice). Please dont freak out about this as much as I did!

After 7 days, my balls were much less swolen but still bruised and tender. The perinium was still reddish and there was still a little bit of discomfort but not too much. Pain had all but gone. I didnt need painkillers at all. I could walk around easily, but expect to feel pretty dizzy and confused when walking. Sitting in bed for a week really has its side efffcets! The last of the general Aneasthetic side efects had gone, this was mood swings and generally felling confused. I was still getting the mucus/blood after erections until the 10th day.

3 days ago, I had my catheter removed. This is painless and takes 2 seconds. The results? I cannot describe how good you will feel! I burst out laughing with excitement on my first wee! I thought the power would lift me into the air and through the roof! Its just the most amazing feeling in the world to pee noramlly. For 6 years I would stand at the urinal in the Pub and watch 5 - 10 blokes finish before I had, now im in and out of the toilet in 5 seconds! Truly amazing! I still have discomfort with erections at night, but I was told this could take up to 6 weeks to fully heal and is totally normal.

I would recomend this to anyone who its been suggested to. And I would do it again in a second. My only regret is not getting it done sooner, but I was so terrified by the urethrotomy that I put it off! Seriously, go and get it done! But only get it done by a surgeon who is experienced. I think most of the problems with urethroplasty are when the surgeon is not experienced or the patient is not taking care to recover properly. Im in London and i would recommend my surgeon Mr Watkins to anyone. He is a genius and a lovely bloke too, and has done this op 500 times.

Hope this can relax a few people. Stress and  worry can have the worst effects on you and I should know as I suffer from anxiety but I think that most of it was due to not being able to wee properly. Good luck and don't delay! This will turn you into a new man!
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Avatar_m_tn
Hi zoltan85 - sounds like you've had a really good urologist. Is this the Mr Watkins at St Georges hospital in Tooting? I may need this procedure so need to find the right surges as it appears crucial.
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Avatar_m_tn
Hi zoltan85 - Can you please confirm if this is the Mr Watkins at St Georges hospital in Tooting?I have been referred to Mr Watkins at St Georges for Urethroplasty procedure.Thanks.
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Avatar_m_tn
Hey I'm really sorry for the late response. Yes its Mr Watkins at St Georges. He is an expert in the field and you will be in very capable hands! Be sure to ask him about any concerns and also you must insist that he does the procedure and not someone else if you are going through the NHS. The NHS have a knack of trying to get you through the system quicker and may offer you the procedure earlier with a different sergeon. GOOD LUCK :).
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Avatar_m_tn
wHO IS YOUR DOC
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Avatar_m_tn
wHO IS YOUR DOC
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Avatar_m_tn
Hello,

I had my urethroplasty done on 11/28.  I am one week away from getting an xray done to see if everything has healed properly.  I am praying everyday that my xray will come out positive.  Looking back the last couple of weeks I think the worst part has been the cathedar.  I have only been out to the mailbox since my surgery.  I have been dealing with strictures for 25 years.  I couldn't take it anymore.  So I decided to get the surgery and hope that I can finally urinate like everyone else.  I will post again after my dye test on 12/20.  I just want to see how things are going for you as of now.  I hope that you are doing well.  Also anyone else reading this who needs any reassurance please GET THE SURGERY.  YOU HAVE A GREATER CHANCE OF FINALLY BEING ABLE TO PEE LIKE ALL THE OTHER GUYS.  Feel free to ask me any questions.  I would be more than happy to share my experience with you.
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Avatar_m_tn
Update....My retrograde urethragram went very well.  My doctor was happpy with the results of the surgery.  So my cathedar finally came out after 3 weeks of being my best friend.  As of now I am 5 days cathedar free and peeing very well.  You will feel like a superstar the first time you urinate.  The first day is was like a fire hose.  The flow will come down a small notch on day two.  But the flow should be very powerful in comparision to before the surgery.  The only negative comment that I have is that my balls are a little tender and sore.  I was told that it will take a few weeks for this slight pain to go away.  I will provide another followup afer my one month surgery appointment with my doctor.  
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Avatar_m_tn
So I've been trying to read up on urethroplasties online, but there's not a lot of literature on the subject (unfortunately for everyone who is considering having one.) I had stage 1 of 2 of a buccal mucosa urethroplasty on December 17, 2012, and I made it a point to write down my thoughts each day so that people looking for information can find my experience and get an idea of what it's like. Without further ado…

Pre-Surgery: I am 19 years old, male, and suffering from a urethral stricture caused by failed hypospadias surgery in 1994 and resulting bxo scar tissue. Symptoms began in January of 2012 for me and worsened until I finally saw a doctor in June. I was dilated the end of June, but symptoms returned (don't ever do this it was the most painful thing of all time.) I set the date for surgery in August 2012, and self-cathed for 3-4 months until my surgery in December.

2 Days Before Surgery: Developed a urinary tract infection just before the surgery (good timing?) I could no longer void on my own and it was unbelievably painful to even try. Spent the first 6 hours of my winter break in the emergency room waiting for the results of a urinalysis test and then placement of a painful Foley catheter.

Day 1 Post Surgery: First thing I notice is an extremely annoying block on the left side of my mouth where the graft was taken. At this point, the graft site is way more painful than surgery site which is heavily bandaged. It was extremely hard to get out of bed the first day. A supra-pubic tube was inserted that caused me the most pain out of anything. Life at this point ***** a lot - spent the night tossing and turning in the hospital in severe pain despite morphine - but I'm finally on the road to recovery and hopefully a normal life.

Day 2: The first night at home was rough. Woke up a few times in pain, both in the cheek and surgery site. My face is disgustingly swollen and it tastes like a giant pizza burn on the entire left side of my face. I can get out of bed and walk around a little bit, with the help of an aide and my dad.

Day 3: My cheek is still absurdly large and sore and starts bleeding when I try to eat. Should make a note to make sure you get soft foods obviously. However, eating ice cream and pudding was still painful for me by the 3rd day. The pain from the catheter disappeared mostly by day 3, and I'm almost completely mobile. Impossible to sleep through the night because of erections (MOST PAINFUL THING EVER.) Found out later that the bandage was actually stitched to my penis so that's why it hurt so much.

Day 4: Things were actually not terrible by day 4. The only issue remains sleeping through the night without waking up in horrible pain which frustrated me. A huge chunk of the inside of my cheek came out which was just a lot of dead skin, and now it hurts even more to eat.

Day 5: Woke up a few times in the middle of the night with SEVERE pain in the penis. Reached down and felt a pool of blood and kind of freaked out. Cleaned it in the middle of the night only to have it happen again. Called the doctor in the morning to see what was going on, and it he said I was far too along in the recovery stage for there to be any problems. Most likely cause was a bladder spasm from the inserted catheter that pushed blood through the opening (talk about fun). I'm no longer sore when trying to stand which makes the days more bearable, but the mouth has started to become very painful. Started using chloraseptic mouth spray to numb the pain which is heaven for the 30-45 minutes that it works. Biggest concern is making it through the night without more blood

Day 6: This was actually the most painful wakeup I had. There was only a little bit of blood which was encouraging but still not fun. Both my mouth and surgery site were killing me when I woke up and the effort it took to get out of bed was enough to make me dizzy. Throughout the day, my mouth hurt a lot and I just used the chloraseptic spray as often as I could. Tomorrow is follow up appointment day. Nervous to see what it looks like

Day 7: Today, the bandage finally came off. Can't even begin to describe how painful that was for me. Doctor put cold water on it beforehand which was nice, as it was the first time in over a week. Also said that the graft looked great and took nicely. I knew that it was going to look bad, but it still kind of surprised me as to how bad it actually looks. The doctor recommended leaving the supra pubic catheter in for another 2 days just in case I had some trouble voiding on my own. First time was the most nerve wracking thing of the entire surgery, but it went EXTREMELY WELL. This was one of my biggest fears, and I want to put people's minds at ease and let them know that there's nothing to be afraid of. While it was a little awkward to have a hole below where I'm used to having it, there was no pain, and no blood after the first time peeing on my own. Also underrated was how much stronger the flow was compared to what I was dealing with before the surgery.

So that's a summary of how I felt and the things that I noticed in the first week post-op for a stage 1 urethroplasty. I hope that people can look at my experience and better make a decision about their own surgery. At this early point in my surgery, I would recommend it to people really struggling with urethral strictures, but know that it's going to be a long and painful process to get back to full health. I'm really looking forward to that first day completely without pain and the first time I can go back to playing sports. I'll post again in a few weeks/months when I have more updates. Good luck everyone.
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Avatar_m_tn
I see many posts for people that have had this surgery. Some positive some negative. Almost all of them are telling of their stories from pre-op to 6 weeks post op. I would like to hear from those of you that have posted and or have had the surgery at least 2-10 years ago.

I was first diagnosed around 1984 28 years ago and have had several procedures. I am considering urethroplasty. My stricture is 3-4 cm long. After other procedures my flow was always very good and after time slowly got worse requiring  another procedure. So when i hear how great the surgery is that you are peeing better than ever it does not impress me because the surgery was just completed and things haven't settled down. i would like to from those same people years later are you still symptom free?

if not how long did it last before you need another procedure?

Thanks,

Skip
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Avatar_m_tn
Hi,
haven't been on the site for awhile sorry about the late response. I am at month 9 since surgery. My flow is very good, with no retention (if you have a stricture the retention never completely voiding *****)
I have a very high pain tolerance even had the two way camera (one through superpub other through penis) without anesthesia before main surgery so probably can't comment on how much it hurt. Altough the swelling and the feel someone kicked you square lasted a month or two it was not continuous.
I cannot stress how important the doctor and the hospital you are having the surgery are. I am fortunate to live the the Washington DC metro area and have some of the best in the world around here. Seems like the horror story (left hospital, infection, etc) must have been a bad area of the world to allow that to happen due to liabilities as they are...
My Doctor is Dr. Chrouser and has moved from our area to work at the University of Minn. Her attention to detail is awesome, her success rate is near perfect as well she has done numerous urethroplasty procedures doing many in third world nations in doctors without boarders (or something along those lines)  So my advise get a good hospital great doctor who has done a lot of these procedures if there is not one close find a way to get to a good doctor/hospital
As for size erection , etc. I may have lost a small amount of length but still have enough, no issues with sex (pain ejaculation, etc) no issues with the bladder infections I used to get alot life is good....
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Avatar_m_tn
Thanks for the reply.
How is your condition now?I am having my surgery in May 2013 by Watkins.
I have been told of 1 day Hospt stay and 10 days rest.Is it enough recovery period?
When can I start driving to work as my workplace is 50 miles .Any ideas.

Thanks.
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Avatar_m_tn
Also after what day the Cather is taken off? is it after 10 days?
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Avatar_m_tn
This is an update, for the story (Rich1960).  I now live in a different part of the country I've been to Kuwait for a year and have settled in Athens Alabama.  I do not recommend having urethroplasty.  I have continuous pain, my scrotum is on fire daily sometimes it's worse, to the point that I cannot focus.  My errections are painful, the scarring has shortened my errection by more than an inch,  The errection is now growing crooked, and causes pain for my wife during intercourse.  The internal pain from the urethra is bad, I never know when I go to urinate if the pain will bring me to the tips od my toes or just cause me to break out in sweat.  I still get infections and have blood in my urine.  My son has urethral strictures and is starting down this long path.  I cannot recommend he get urethroplasty, it has caused me to wish I had never done it myself.  
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Avatar_m_tn
See my post Rich1960, I updated it today.  
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Avatar_m_tn
Hello,
Thanks for the most useful information. I am scheduled to a major urethroplasty with possibly a 2 stage repair in a month. I was wondering if the sensation on your penis during sex got better as time went by?
Many thanks,
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Avatar_m_tn
Just wanted to add my story for those facing this.

Background: age 50, have had urethral stricture problems since having hypospadia surgery at age 10 or so.  Have had several hundred dilatations and spent the past several years self-cathing once a week until it reached the point this spring where that became extremely difficult.  I had a failed DVIU in early summer where the doctor just punted because my urethra was too damaged and he put in a supra-public cath which I have had since.  This was just capped off with a plug that I removed whenever I felt the need to void and was much easier to deal with than a leg bag.  The solution was not ideal though as my finger tips got extremely sore from having to pry the cap off several times a day and on a couple of occasions the cap popped out on it own resulting in the extremely embarrassing result of peeing my pants with no ability to stop the flow.   I ordered a tru-flow valve on-line which made opening the cath much simpler and I never had it pop out either.  My local urologist referred me to an expert a few hours away for a urethroplasty.

I had buccal mucosa graft urethroplasty done two weeks ago at Wake Forest hospital.  I had long strictures at a couple of spots , 1 bulbar and 1 in the penis.  I was in the hospital for just 1 night (still considered an out-patient procedure).  My surgery lasted for 4.5 hours actual surgery time.  Several hours later I was able to eat some soft foods without much problem.  Granted my pain threshold is probably higher than most (probably a result of the several hundred dilatations which really suck).

I was released from the hospital the following morning after my wife was shown how to help me change my dressing on my penis (which of course is splayed open with some of the grafted tissue).  The bulbar stricture was fully stitched up and hasn't been a problem other than watching how I sit and making sure I avoid getting constipated.  The pain has not been too bad, in fact I never took any of the pain meds they gave me, just ibuprofen for a few days.  My energy level has still not returned to %100 though and night time erections are uncomfortable (but not extremely).  I still have the supra-pubic cath and I now have a foley cath through my penis which drains into a leg bag.  This has been a bother since it sometimes slips down my leg, has leaked a time or two and is just a nuisance.  My number 1 complaint would be some pain/itching in my scrotal skin, hydrocortisone cream seems to be helping.

I go tomorrow for a 2-week followup and hope to get good news.  My mouth stitches have all healed and I have been eating anything I want.  I do feel some tightness on that side if I open my mouth wide. The graft  on my penis seems to be healing well (after some initial concern of the area looking very dark) so I'll see what comes next.
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Avatar_m_tn
Hi folks. Just wanted to add my 2c to this.

I've had a stricture for my entire life (as far as I can tell). I'd had it so long, I didn't realize it was a stricture until my girlfriend encouraged me to go get looked at because it was taking me forever to pee. Long story short on that, the doc did a (failed) cystoscopy and discovered the stricture, then a RUG and determined that it was probably less than 2 cm.

The first specialist I was at was new. He said I should have a DVIU performed (I believe he was correct on this). I did, had a cath in for 3 days, then went back on my way. He told me to self cath 3 times a day for at least the first month. This was where I figured this guy was wrong. I found this guy through a referral from my PCP. At this point, I did some googling for the best Urologist and found a very high ranking fellow at Johns Hopkins. I emailed him about my situation and the cathing a surprisingly got an email back right away saying that (generally) that much cathing could be traumatizing to a urethra and that I should see him. I set up an appointment with him and his charisma and bedside manner won me over instantly. It was seriously night and day difference from my initial urologist (fresh out of school) to this guy who has over 30 years experience and is primarily a surgeon.

We monitored the situation and, as I expected, my stricture came back. Unfortunately, it jumped in how bad it was while he was out of the country, so I had to wait a little to get in to see him. At this point (weeks prior to surgery) I had to stop having sex due to my stricture's reaction to it. We performed another RUG that showed the stricture and that together with the major problems I had been having urinating caused me to agree to have the surgery. I should note that this guy has easily performed over 500 urethroplasties, so I'm confident I was in good hands.

The time from scheduling to surgery went by like a blur. I couldn't really comprehend what I just signed myself up to do. But I took solace (and still do) in knowing I really had no other options. After a failed DVIU, there's really no other options for long term solutions to this problem.

I had my Urethroplasty about a week ago. They put me under and did their cutting. Waking up in the recovery area, the worst thing by far was actually my hands. I have carpal tunnel syndrome and I guess they put my hands at a bad angle for about 3 hours. The first two fingers and thumb on both hands were numb and tingly for about 4 days (suck!). The surgery site wasn't all that bad actually. Well, it got more painful when I tried to move, but laying still it was alright. It was an asatomotic (sp?) so I didn't have any graft taken from my cheek. I had asked previously since my research online showed me that buccal grafts were less likely to have sexual side-effects (being 27 this is important!). However, he didn't think it would be a problem for me, and since the information online is limited, I've put my trust in his judgement.

I was discharged the next day (out-patient). Unfortunately, this exactly coincided with Thanksgiving, and we had already planned on having family over, so this was challenging. My scrotum was larger than an orange and was colored mostly black and dark purple. This was a bit concerning, but it appears to be normal and since day 3 or so has been steadily reducing in size and color. I have no idea how my perinium looks since I refuse to look at it. My girlfriend says the stitches look fine. We did find a staple resting on my butt hole (found this at home), so I'm a little concerned that maybe they accidentally dropped one inside me. I think an x-ray should pretty easily find that, so maybe I'll ask about getting one just to be safe.

The doc says that my stricture was 1cm in length. He apparently took a picture of it for me, but I was too messed up from the anesthesia to talk to him about it. Also, I don't think I've had any reactions to the general anesthesia (energy is normal,no mood swings, good appetite, etc).

The Foley has been a REAL pain. Sitting by itself it's ok actually, it's the erections. I haven't gotten a nights sleep since I came home. Also have been freaking out a bit about what appears to be blood coming out the tip of my penis. An earlier post mentioned that is likely urethral mucus, so that's a good sign (been thinking I've re-strictured it somewhere). My doc didn't give me much direction on bed rest. From my own research I knew that I shouldn't be moving around too much but the nurse seemed to think I needed to walk around a little to get blood flowing. Thus I've done a little walking and standing, and wouldn't consider myself on bed rest. Haven't left the apartment however.

I go in to have my Foley removed on Friday. That can't come soon enough! Then, hopefully, I start slowly getting back to normal life (minus the lifting and sex for a while).
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Skip1962 this is Rich1960 responding to your question about post surgery out a few years.  I am now 3 years post procedure.  I do not believe it was the right procedure for me.  I mat have waited to late in life to have it done.  The length of the stricture I had was longer than anticipated.  The doctor did not tell me everything or enough for me to make an informed decision.

Good- I can urinate better, not as well as I had hoped.  I still have pain and still get infections and the pressure to force urine out has created other problems.

Bad- My mouth healed but I have large raised scars, that get in the way when chewing food, they are a constant irritant.  My scrotum, is still very painful, not sure why but whenever the testicles move I have pain.  The area constantly itches.

Worse- The additional skin removed from my shaft to assist in creating the urethra is a amjor problem, it has shortened my length and makes erections very painfull and in fact has started to create an unatural curvature in my penis.  This creates intimacy issues.  

This is my feedback, if I had to do it all over again.....for me I would not do it.  But, that is something each person has to decide, maybe things would have been different if I's of had the surgery years ago.  Maybe not...
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Avatar_m_tn
Yes, that is a big part of the process.  My scrotum and testicles were swollen for weeks.  When they finally started to get back to normal...at least size wise then I noticed that when the scrotum was loose/soft my testicles were killing me even more.  

At this stage, over 3 years post op, I have very little feeling in my penis other than the pain cause when it reaches erection and pushes agains the scar tissue.  

I hope you have better results.
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Avatar_f_tn
Chaps, man up!

Nobody is going to recommend you have something done unless they think you will benefit from it!

I am a few months post first stage urethroplasty, and although having a splayed penis is a surreal you soon get used to it, and I can see things getting back almost 100% to normal after the second stage.

I keep thinking back to days lying on a hospital bed with a bursting bladder waiting for some Dr to come and give me some medieval treatment trying to force a catheter or some other weird implement down my snake eye. I would often try to sort myself out - once with a grass reed on the banks of the Nile whilst back packing through Egypt.

After 20 odd years of this i'd had enough and found the best surgeon I could find,

Basically, I have Lichen Sclerosis and my stricture was about 4cm in my helmet. So during the first stage they split open my gland and reconstructed my urethra from a buccal graft.

Aside form the familiar discomfort from the catheter, the= procedure and post op was pretty painless, a big factor in this is the local nerve block they use  to tame the post op pain.

My worse point was probably googling the complete numbness after a few days post op, as I was expecting to get some feeling back, and I realised there are sp,e poor chaps who  have lost sensation etc form the operation. - I thought to myself how on earth can they slice you in half and retain all the nerves etc!? Anyway within a couple of weeks it was back and the little man was back in action with the Mrs (and on his own). Sensation and size etc is all 100%.

Peeing is messy at the moment but an incredible relief each and every time. No worry that nothing will come out and I will be going through hell over the next few hours, just a wonderful woosh of pee.

The only complication which my surgeon mentioned  is that the graft is a slightly different colour around the meatus, so this means if you look closely I will look a bit like Mick Jagger.

But this is beats looking like Paul McCartney as far as I am concerned.

I can highly recommend this procedure, but as with anything, its well worth finding out what kind of care is available to you. I wouldn't want to have this done by anyone.

Good luck!
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Avatar_m_tn
Lots of great experiences, and feedback here. Very helpful, thanks to everyone that posted personal experiences.

I am a 32 year old male and underwent a Buccal Mucosa Graft Urethroplasty for a Bulbar stricture repair. Never had any dilations, or invasive procedures in the past - chose to go with Urethroplasty straight away owing to success rate, and the fact that I wanted to get over with this once and for all (hopefully!).

I am in my second week of recovery - it hasn't been uneventful though. Although there were no complications directly related to the surgery itself there was a bit of an accident - I was taking a nap (I have the habit of putting my palm under my chin when I sleep) and I accidentally pressed hard on my chin (the buccal mucosa graft site) and bit into the cheek tissue (wound). Caused profuse bleeding from the wound, the wife and I freaked out but bleeding stopped in 20 mins after putting an ice pack on the chin and pressing on the wound with some cotton. So, word of caution, please try not to sleep on the side where the buccal mucosa graft was removed.

Most recently, I developed a fever and the temperature went up to 101'F. We immediately presumed that this could be a post-op urinary tract infection due to bacterial spread (happens due to improper catheter care). I was telling myself there's no way that could happen because I was SUPER careful with the catheter and cleaned it everyday! Anyway, turns out the fever vanished overnight with a dose of paracetamol (which means that a bacterial infection is unlikely) but we still went and gave urine samples for a culture routine at the hospital. The urine routine will tell if there is an infection at all, and will take a couple of days to come (I'll update here as soon as I have the results).

My catheter stays for a total of four weeks per recommendation, and comes off in two weeks (I'm SO looking forward to it).

Now, some questions I'm hoping someone can answer:

1. Anybody know how long one should wait before having sex after the catheter comes off? I see varying responses online in general so specific to a Urethroplasty, how long should one wait after the catheter comes off?

2. How is normal erectile function and sexual function after the catheter comes off? Anyone with a Buccal mucosa graft at bulbar stricture have experience here?

3. My doctors said there's no need to do ANY tests while the catheter comes off (they're so confident about their reconstructive surgery). But I've seen multiple folks had to take RGU or VCUG. Anyone had to go through RGU or VCUG while the cath comes off?

Thanks for all the feedback! And BTW, I'll be happy to answer questions on pre-op considerations, post-op care, etc. I'm not a doctor but I've spent so much time researching on this topic, I think I can answer some questions :)
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Avatar_m_tn
HI im Aaryan,24...im from bangalore(india) and im also one of them whos suffering with stitcher urethra..i had got stage1 operation in the year 2009 and from tat time ma doctor has adviced me for daily self catheterisation... i perform self catheterisation on each n every day with safety n precautions.. once im done with it i vill have a peacefull day at work.. but f i dont perform for one day the next day i vill be having problem in the urine flow, burning sensation and the urinary tack size would had got reduced.. I'm fed up of ths daily catheterisation since i dont have that peacefullness of travelling or working in other city bcz i should keep ma kit wid me ... Recently i visited a doctor in Manipal(senior urologist) who gave me few tests n asceding urethrogram.. i did with the test n my doc found that i have stitcher ranging from 3-4cms.. he has given me a option of getting it operated by ursoplastic surgery or perform daily self catheterization... i juss need u guys to help me out frm ths n telme whch can be more helpfull for me...

1.After uroplastic surgery will i hav any sexuall problems???
2.Should i perform self catherisation after uroplastic surgery???
3.Can i manage ma life without surgery n daily self catherization???


Guys pls help me out with this.. im very much depressed in ma life.. i dont wanna end up ma life at ths early stage bcz of deppression.. pls help me out ....
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Avatar_m_tn
Where do you find the top doctors on this procedure?    I have tried but nothing is coming up.    I will go wherever I have to.    Oklahoma, Missouri and Texas is our closest locations.    I want someone that has performed the procedure a lot and is well educated in it.   Please help.
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