Scar Tissue Stricture Post RP Self-Cath

[HFLEric]

R RP Prostatectomy 15 MAY 08

I have a scar tissue stricture at the bladder entrance. It sealed off a month after the surgery. My UR sent me home with a Red Foley for a week, and French caths to use every other day for a while, and then twice a week. When I did it twice a week after the first couple times it was hard to poke through the stricture.

I have reverted to once every other day. I'm hoping this will be OK. I've had no problem, and hope this doesn't interfere with my slowly building continence.

ANy input would be appreciated.



I go in in two months for my  "second visit". I had a post op PSA of .5, and a gleason 5 area in my seminal vessicle. I was started on Trelstar a month ago, and have had no side effects, pain or anything else except the emotional tidal waves which are subsiding somewhat through support, and returning to work.

Thanks for any suggestions.

HFLE

[HFLEric]

Just an Update in brief.

Went in for a three month after Trelstar check and the PSA was down to .05 from .5.

Doc says that it's best to continue in this vein for up to two years, and remove the Trelstar and see what happens before trying Radx/Chemx if then.

Cathetering is less frequent and the red silicone ones work very well. I might get in to have him snip some scar tissue, if I get the urge to drag a Foley around for a week or two...

I tried Lexapro for a couple weeks but was better without it. I tapered back to nothing.

Now I take ONE simple Vicodin first thing in the AM, and NO MORE at any other times, and it totally cut my emotional "negative cycle". Those SRRIs are a little much for my mind, and more than I need...

Overall, the doc showed me off as an example of VERY full and fast scar healing, and is happy in my progress.

Any input I can get from you, I appreciate.

Thanks.

No real bad side effects from the Trelstar, but you have to be REAL careful not to let muscles atrophy, as I found out. Mood problems or "crying spells" I noticed way before I started Trelstar. They started right around the biopsy and scans..

Anyhow, Thanks Dr H and any input I'd appreciate, like I said.

Eric L

[HeinrikMD]

Hi,

It is hard to say who will be better off with the catheter and who wouldn’t be. Hence, the question as to whether your current efforts will not really make a difference in the long run is difficult.

Part of the reason why the catheter fails would also be the initiative of the patient to stick with it. There would be patients who would tend to use the cath only when it becomes absolutely necessary, they would also be more likely to fail in the long run.

Even the surgery, laser or otherwise, could have re-stricture as a failure, so I think the attitude of “not wanting to be an in-patient” anymore is good, because the operative intervention isn’t clearly a winning option.

[HFLEric]

I left a message that I was going to revert to every other day unless I heard back. He was fine with it.

I had a 37.35 PSA preop. One lymph node involved, out of the 15 he removed with "margins" and a seminal vessicle with a +5 gleason tumor in it when all was analysed in Post Op Pathology. He said all the margins he found were "clean" in Pathology.

He said that the .5 meant that they did not get it "all" unfortunately and Trelstar for three months and then a retest will tell us which direction to go. I've read that in some cases it will drive it down to 0, and it will stay.

I think we have a good handle on that part of it, though  it's a tough one.

I just wondered if anybody had input as to the scar tissue issue and if indeed self cathering might make an opening permanant or if I'm just putting off getting it cleared out or resectioned. I've been reading that lasering is possibly the most affective.

I saw it on the scope when I went in. It is a flap of skin that grew across the middle with two holes in it. The Dr enlarged one with a pointed cath, installed a Red Foley and sent me home with some 22 Frenches ( I think that's the number). I took the Foley out after 4 days, with instructions to cath every other day, twice a week, etc.

If I have a choice, I don't want to be back in "in Patient" status, and if POSSIBLE not sent home with a 4 week Foley Ordeal after more surgery......

I don't mind self cathing, but it's not the high point of my day, that's fir sure...

Again, thanks for any input. I'm not sure how strictures work, what they "tend to do" or how they are dealt with.

Mainly whether self cathetering is just putting off surgery for it.

Thanks.

EJL

[HeinrikMD]

Hi,

There is no clear guide as to how long the catheters would be needed. Hence, there doesn’t seem to be any specific problem with the intermittent pattern that you did describe. Over time, you could re-attempt to make the catheterization less frequent. Report your progress with your urologist. At some point you may need to consider a surgical intervention if the stricture persists or worsens.

If other problems arise, then it may be better to inform your doctor soon.
The PSA after prostatectomy should be in the undetectable range. What was the baseline value (before the surgery)?