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Urethrotomy -- what should I expect for healing/recovery
post urethral striture - urethrotomy
by dan120748, 1 minute ago
I just went through the urethrotomy and was told it would take care of my inability to fully empty my blader - after returning to the hospital today they told me I would have to use a daily catheter - will this be for ever or just during the healing process -- no one seemed to be able to give me an answer.
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Hi.

I am having a Urethrotomy to remove a stricture in the next few months due to weak urine stream and an infection last year.

From what I understand you will have to use a catheter to make sure the area where the stricture is does not close up.  You do this often at just after the op, then more intermitently over time.  

I have read that some people have to do it once a week for years, but this is far better than the complications that can be caused by not havign the stricture sorted.
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> I have read that some people have to do it once a week for years,
> but this is far better than the complications that can be caused
> by not havign the stricture sorted.

Obvioulsy, though, if you have to keep doing repetetive dilations or urethrotomies, the stricture hasn't been "sorted". This is just managing the condition.

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How to Pass the FRCS(Urol)

Q. Describe, in general terms, how you would manage an anterior urethral stricture:

Avoid the so-called ‘reconstructive ladder’ where several urethral dilatations are followed by several optical Urethrotomies and eventually definitive surgery in the form of an Urethroplasty. This sequential process may extend the length and depth of the stricture increasing the complexity and compromising the outcome of Urethroplasty.

Aims of treatment of urethral stricture disease – firstly define the goal of treatment, which essentially is whether the patient wishes his/her stricture to be managed (periodic dilatations or Urethrotomies) or cured (by Urethroplasty).

http://depts.washington.edu/uroweb/print/pdf/urologyNews_howto_06.pdf
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> after returning to the hospital today they told me I would have to use a daily catheter -
> will this be for ever or just during the healing process -- no one seemed to be able to
> give me an answer

... and they didn't discuss this with you _before_ surgery??

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... the stricture inevitably recurs when the patient stops self-obturation, regardless of how long it has been used

CAMPBELL-WALSH UROLOGY 9th ed.

CHAPTER 110. Surgery of the Penis and Urethra
http://www.fk.uwks.ac.id/elib/Arsip/E-Library/e-book/UROLOGY%20AND%20NEPROLOGY/CAMPBELL%20-%20Urology/chap110.pdf

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Self-catheterization is a traumatic maneuver that most patients view with considerable disdain as a painful, time-consuming, embarrassing, difficult and unnatural practice they would gladly abandon if given the choice. False passages will develop in most cases over time, further complicating the problem. Today we can and must do better.

Urethral Stricture is Now an Open Surgical Disease
Allen Morey
Department of Urology
University of Texas Southwestern Medical Center
Dallas, Texas
0022-5347/09/1813-0953/0 Vol. 181, 953-955, March 2009
THE JOURNAL OF UROLOGY®

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Repeat Urethrotomy and Dilation for Urethral Stricture Disease is neither Clinically Effective Nor Cost-Effective

http://www.urotoday.com/urologic-trauma-and-reconstruction-1345/repeat-urethrotomy-and-dilation-for-urethral-stricture-disease-is-neither-clinically-effective-nor-costeffective-1277.html

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Urethral Stricture Tips

The literature is relatively uniform in stating that the patient who may enjoy success from an internal urethrotomy or dilation with curative intent will have a short segment stricture (1 to 1 1⁄2 cm.), will have relatively superficial spongiofibrosis, and the stricture will be located in the bulbous urethra.

The success rate for internal urethrotomy and dilation for strictures other than in the bulbous urethra is dismally poor.

There is also ample literature which states that repetitive dilation and internal urethrotomy never proceed to cure, but they certainly proceed to spreading the stricture disease, making reconstruction more difficult, and making the results of subsequent reconstruction less than they would have been should the stricture have been addressed initially.

http://www.medicalnewstoday.com/articles/117793.php
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EDITORIAL COMMENT

... this article also casts doubt on the practice of self-catheterization to try to keep strictures open after urethrotomy.

Of these patients 73% had recurrence on a self-catheterization regimen and another 18% had so much pain with catheter passage that they had to abandon it. Again, few reconstructive urologists attempt this maneuver since it always seems to fail, not to mention that it unnecessarily condemns the patient to a lifetime of painful self-catheterization, which would not be necessary after surgical cure by open urethroplasty.

An excellent study by Greenwell et al suggests that self-catheterization has no value, at least for anterior strictures,1 and the current authors add doubt about its usefulness for posterior urethral distraction injuries. This suboptimal management scheme remains wildly popular, judging by the referral population seen at our clinic, despite the real doubts as to its efficacy. It is another specter in need of a stake to the heart, in my opinion.

Richard A. Santucci
Department of Urology
Wayne State University School of Medicine
Detroit, Michigan

THE JOURNAL OF UROLOGY®
Copyright © 2007 by AMERICAN UROLOGICAL ASSOCIATION
Vol. 178, 1656-1658, October 2007

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*** in need of a stake to the heart ***

Well said!

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So what do u want people  do if every thing is useless less effective . Very depressive.
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