Aa
dilation of uretha because of scarring
i have scarring in my uretha. Is dilation the recommended procedure?
This discussion is related to Urethra Dilation - Consequences.
This discussion is related to Urethra Dilation - Consequences.
MEDICAL PROFESSIONAL
Hi,
Its good to know that your quality of life has improved with medical intervention.
The BPH is a condition that can be managed without surgical intervention as long as you have a good response to prostate-specific medication.
Avoid caffeine, alcohol, and spicy foods as these can aggravate prostate conditions.
And remember to keep fluid intake over 2000 ml.
Regards
Its good to know that your quality of life has improved with medical intervention.
The BPH is a condition that can be managed without surgical intervention as long as you have a good response to prostate-specific medication.
Avoid caffeine, alcohol, and spicy foods as these can aggravate prostate conditions.
And remember to keep fluid intake over 2000 ml.
Regards
Dear Dr Mathews:
My long time and very qualified urologist had logically came to the conclusion that the scarring of my uretha was causing my difficulties.
That was a logical conclusion.But as it turns out it was not the only conclusion.
It seem that I have Bph also and I have been on uroxatral for over a week with good results.Over 75% of my complaints have diminished or dissappeared.
I am not facing the invassive procedure that I was dreading. hank youf or your kind concern
My long time and very qualified urologist had logically came to the conclusion that the scarring of my uretha was causing my difficulties.
That was a logical conclusion.But as it turns out it was not the only conclusion.
It seem that I have Bph also and I have been on uroxatral for over a week with good results.Over 75% of my complaints have diminished or dissappeared.
I am not facing the invassive procedure that I was dreading. hank youf or your kind concern
Thank you for your competent and professional analysis of the choices that are open to me.
I dread any invasive procedure and have decided not to have the stretching doen until iI am forced to do so and have no other choice.
I will keep you posted if circumstances change
\
Thank you again
I dread any invasive procedure and have decided not to have the stretching doen until iI am forced to do so and have no other choice.
I will keep you posted if circumstances change
\
Thank you again
MEDICAL PROFESSIONAL
Hi,
The benefits that dilatation can provide will need to be evaluated against the costs - the pain and discomfort, the visits to the hospital and the monetary costs.
At present, conservative management involves the following:
"Instrumental Treatment
* Intermittent dilatation (at suitable intervals, twice a week 1st, once a week for month, once a month for a year, then once every year)
* Bougies of increasing size (gum, elastic, continuous dilatation)
* Continuous dilatation"
http://en.wikipedia.org/wiki/Urethral_stricture#Instrumental_Treatment
So, you will need to make an informed decision based on the information (surfeit of :-))
you have with you.
As MSKshelly has pointed out, the procedure can cause unnecessary discomfort if you go in without appropriate preparation.
If you feel that you will manage to receive required care with reference to pain mangement and support during and after the procedure, then go ahead with the procedure.
Even though individual patients react differently and have varied results to any procedure, you may feel better for having had the conservative intervention once your condition improves.
Do keep us posted on your doubts and progress.
Regards
The benefits that dilatation can provide will need to be evaluated against the costs - the pain and discomfort, the visits to the hospital and the monetary costs.
At present, conservative management involves the following:
"Instrumental Treatment
* Intermittent dilatation (at suitable intervals, twice a week 1st, once a week for month, once a month for a year, then once every year)
* Bougies of increasing size (gum, elastic, continuous dilatation)
* Continuous dilatation"
http://en.wikipedia.org/wiki/Urethral_stricture#Instrumental_Treatment
So, you will need to make an informed decision based on the information (surfeit of :-))
you have with you.
As MSKshelly has pointed out, the procedure can cause unnecessary discomfort if you go in without appropriate preparation.
If you feel that you will manage to receive required care with reference to pain mangement and support during and after the procedure, then go ahead with the procedure.
Even though individual patients react differently and have varied results to any procedure, you may feel better for having had the conservative intervention once your condition improves.
Do keep us posted on your doubts and progress.
Regards
should urethal dilation because of a stricture be done for moderately severe problems?.
I have had this situation for some time and have been living with it .Can not say that i will ever get used to urine running down my pants leg but
Will the "cure" be worst than the problem?
"
MEDICAL PROFESSIONAL
Hi,
In view of your age and the past surgery you have been through, it would be best to just have the dilatation done.
Urethral dilatations may need to be repeated after some time.
Do keep us posted on your doubts
regards
In view of your age and the past surgery you have been through, it would be best to just have the dilatation done.
Urethral dilatations may need to be repeated after some time.
Do keep us posted on your doubts
regards
I have to have urethral dilations every so often, for reasons other then stricture. If you do have to have a dilation I would encourage you to ask your urologist to prescribe some pain medication or valium that you can take before coming to the office. HAVE SOMEONE DRIVE YOU. You can also ask your doctor if you can take AZO or the script form of the same medication prydium. It will turn the urine orange but helps to relax and soothe the urinary system. This can help with the healing process as well.
I believe in the case of a man they automatically use lidocaine gel but if not ask for it!!
Immediately after the procedure use ice. I take one of those insta cold pacs with me, and put it on immediately. Using ice helps to reduce any swelling and inflammation afterward! I have found that my healing time etc. afterward is significantly better when we follow the above. Because the dilation is such a quick process I did it without any medication only once. The problem is that I was more tense making the procedure more painful etc. Obviously the Urologist above has much greater insight into what is best,,, just wanted to share in case it might save you some trouble or pain!
Shelly
I believe in the case of a man they automatically use lidocaine gel but if not ask for it!!
Immediately after the procedure use ice. I take one of those insta cold pacs with me, and put it on immediately. Using ice helps to reduce any swelling and inflammation afterward! I have found that my healing time etc. afterward is significantly better when we follow the above. Because the dilation is such a quick process I did it without any medication only once. The problem is that I was more tense making the procedure more painful etc. Obviously the Urologist above has much greater insight into what is best,,, just wanted to share in case it might save you some trouble or pain!
Shelly
Thank you for your critique'
11 years ago ,at age 82, I had a operation for bladder cancer.Since then I have had yearly cystoscopes ..On every case the results were normal. But in that time ,I developed a scarring in the uretha with a loss of urine discharge of over 50%.
And when I have to empty my full bladder in the middle of the night the flow is greatly reduced.My wish is to find the best procedure to mitigate this problem,
My fear is that at some time I will be unable to void and wind up in the hospital.
Thank you
11 years ago ,at age 82, I had a operation for bladder cancer.Since then I have had yearly cystoscopes ..On every case the results were normal. But in that time ,I developed a scarring in the uretha with a loss of urine discharge of over 50%.
And when I have to empty my full bladder in the middle of the night the flow is greatly reduced.My wish is to find the best procedure to mitigate this problem,
My fear is that at some time I will be unable to void and wind up in the hospital.
Thank you
MEDICAL PROFESSIONAL
Hi,
Medical therapy
"Some patients may opt to manage their stricture disease with periodic urethral dilations. The goal is to stretch the scar without producing additional scarring. It may be curative in patients with isolated epithelial strictures (no involvement of corpus spongiosum).
Surgical therapy
Internal urethrotomy
Internal urethrotomy involves incising the stricture transurethrally using endoscopic equipment. The incision allows release of scar tissue. Success depends on the epithelialization process finishing before wound contraction significantly reduces the urethral lumen caliber. The incision is made under direct vision at the 12 o'clock position with a urethrotome. Care must be taken not to injure the corpora cavernosa because this could lead to erectile dysfunction.
Permanent urethral stents
Permanent urethral stents are endoscopically placed. Stents are designed to be incorporated into the wall of the urethra and provide a patent lumen. They are most successful in short-length strictures in the bulbous urethra.
Open reconstruction
Primary repair
Primary repair involves complete excision of the fibrotic urethral segment with reanastomosis. The key technical points that must be followed include complete excision of the area of fibrosis, tension-free anastomosis, and widely patent anastomosis. Primary repair typically is used for stricture lengths of 1-2 cm. With extensive mobilization of the corpus spongiosum, strictures 3-4 cm in length can be repaired using this technique. The repair is left stented with a small silicone catheter in the urethra. The bladder is drained with a suprapubic catheter.
Repairs utilizing tissue transfer techniques
* Technical points for free graft repair
*
o Success depends on the blood supply of local tissues at the site of placement.
o Pendulous urethral strictures may be repaired with the patient in the supine or split-legged position. Bulbar or membranous urethral strictures are repaired with the patient in the exaggerated lithotomy position.
o The urethra is exposed through a penile or perineal incision.
o The urethrotomy is made to open the area of the stricture. The tissue graft is harvested from the desired non–hair bearing location, bladder epithelium, or buccal mucosa. The graft is sutured to the edges of the urethrotomy. The graft is covered by the dartos fascia of the pendulous or bulbous urethra. Incisions are closed in 2 layers with an absorbable suture, and a Penrose drain is placed through a separate incision in the suprapubic or perineal areas.
* Full-thickness skin graft: Non–hair-bearing skin should be utilized. It is most successful in the bulbous urethra area.
* Split-thickness skin graft: The split-thickness skin graft is not preferred with single-stage repair because of the contraction characteristics of the graft. It typically is reserved for use in patients for whom multiple procedures have failed and in whom local skin is insufficient for further reconstruction. It is conducted as a 2-stage procedure.
* Buccal mucosal graft: The tissue is resistant to infection and trauma. The epithelium is thick, making it easy to handle. The lamina propria is thin and highly vascular, allowing efficient imbibition and inosculation. Harvesting is easier than other free grafts or pedicled flaps.
* Bladder mucosal graft: It is not as popular as other free tissue grafts because of difficulty in harvesting and handling the tissue.
Pedicled skin flaps
These procedures are based on the principal of mobilizing an island of epithelium-bearing tissue with a pedicle of fascia to provide its own blood supply. Penile skin represents an ideal tissue substitute because it is thin and mobile and has an excellent blood supply.
* Skin island onlay flaps: Transverse, longitudinal, and circumferential island flaps refer to the type of skin incision made to fashion the tissue flap. Dorsal and ventral onlay refer to the position in which the flap is sutured to the edge of the incised urethra, as in the dorsal or ventral position with respect to the urethra and corpora cavernosa. Penile incision is carried out through the skin, dartos fascia, and down to the Buck fascia. A skin island flap is elevated on the penile dartos fascia, which serves as the vascular supply. A lateral urethrotomy is made along the course of the strictured area. The skin island flap then is transposed to the incised strictured area, oriented into proper position, and sutured to the edges of the urethrotomy incision with an absorbable monofilament suture. A watertight subepithelial suture line should complete the flap placement. The skin is closed with interrupted sutures.
* Hairless scrotal island flap: A non–hair bearing area of skin in the midline of the scrotum is used. The tunica dartos of the scrotum is used as the vascular pedicle. This procedure typically is used in complex urethroplasty procedures and is combined with penile skin island flaps to provide additional vascularized tissue for reconstruction.
* Skin island tubularized flap: It can be used in combination with onlay flap when a large obliterated segment of urethra is present. It involves tubularizing the pedicled skin flap over a sound and anastomosing the tubularized edge to the native urethral stump"
www.emedicine.com/MED/topic3075.htm
Do keep us posted on your doubts and progress.
Regards
Medical therapy
"Some patients may opt to manage their stricture disease with periodic urethral dilations. The goal is to stretch the scar without producing additional scarring. It may be curative in patients with isolated epithelial strictures (no involvement of corpus spongiosum).
Surgical therapy
Internal urethrotomy
Internal urethrotomy involves incising the stricture transurethrally using endoscopic equipment. The incision allows release of scar tissue. Success depends on the epithelialization process finishing before wound contraction significantly reduces the urethral lumen caliber. The incision is made under direct vision at the 12 o'clock position with a urethrotome. Care must be taken not to injure the corpora cavernosa because this could lead to erectile dysfunction.
Permanent urethral stents
Permanent urethral stents are endoscopically placed. Stents are designed to be incorporated into the wall of the urethra and provide a patent lumen. They are most successful in short-length strictures in the bulbous urethra.
Open reconstruction
Primary repair
Primary repair involves complete excision of the fibrotic urethral segment with reanastomosis. The key technical points that must be followed include complete excision of the area of fibrosis, tension-free anastomosis, and widely patent anastomosis. Primary repair typically is used for stricture lengths of 1-2 cm. With extensive mobilization of the corpus spongiosum, strictures 3-4 cm in length can be repaired using this technique. The repair is left stented with a small silicone catheter in the urethra. The bladder is drained with a suprapubic catheter.
Repairs utilizing tissue transfer techniques
* Technical points for free graft repair
*
o Success depends on the blood supply of local tissues at the site of placement.
o Pendulous urethral strictures may be repaired with the patient in the supine or split-legged position. Bulbar or membranous urethral strictures are repaired with the patient in the exaggerated lithotomy position.
o The urethra is exposed through a penile or perineal incision.
o The urethrotomy is made to open the area of the stricture. The tissue graft is harvested from the desired non–hair bearing location, bladder epithelium, or buccal mucosa. The graft is sutured to the edges of the urethrotomy. The graft is covered by the dartos fascia of the pendulous or bulbous urethra. Incisions are closed in 2 layers with an absorbable suture, and a Penrose drain is placed through a separate incision in the suprapubic or perineal areas.
* Full-thickness skin graft: Non–hair-bearing skin should be utilized. It is most successful in the bulbous urethra area.
* Split-thickness skin graft: The split-thickness skin graft is not preferred with single-stage repair because of the contraction characteristics of the graft. It typically is reserved for use in patients for whom multiple procedures have failed and in whom local skin is insufficient for further reconstruction. It is conducted as a 2-stage procedure.
* Buccal mucosal graft: The tissue is resistant to infection and trauma. The epithelium is thick, making it easy to handle. The lamina propria is thin and highly vascular, allowing efficient imbibition and inosculation. Harvesting is easier than other free grafts or pedicled flaps.
* Bladder mucosal graft: It is not as popular as other free tissue grafts because of difficulty in harvesting and handling the tissue.
Pedicled skin flaps
These procedures are based on the principal of mobilizing an island of epithelium-bearing tissue with a pedicle of fascia to provide its own blood supply. Penile skin represents an ideal tissue substitute because it is thin and mobile and has an excellent blood supply.
* Skin island onlay flaps: Transverse, longitudinal, and circumferential island flaps refer to the type of skin incision made to fashion the tissue flap. Dorsal and ventral onlay refer to the position in which the flap is sutured to the edge of the incised urethra, as in the dorsal or ventral position with respect to the urethra and corpora cavernosa. Penile incision is carried out through the skin, dartos fascia, and down to the Buck fascia. A skin island flap is elevated on the penile dartos fascia, which serves as the vascular supply. A lateral urethrotomy is made along the course of the strictured area. The skin island flap then is transposed to the incised strictured area, oriented into proper position, and sutured to the edges of the urethrotomy incision with an absorbable monofilament suture. A watertight subepithelial suture line should complete the flap placement. The skin is closed with interrupted sutures.
* Hairless scrotal island flap: A non–hair bearing area of skin in the midline of the scrotum is used. The tunica dartos of the scrotum is used as the vascular pedicle. This procedure typically is used in complex urethroplasty procedures and is combined with penile skin island flaps to provide additional vascularized tissue for reconstruction.
* Skin island tubularized flap: It can be used in combination with onlay flap when a large obliterated segment of urethra is present. It involves tubularizing the pedicled skin flap over a sound and anastomosing the tubularized edge to the native urethral stump"
www.emedicine.com/MED/topic3075.htm
Do keep us posted on your doubts and progress.
Regards
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