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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
59 Responses
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Avatar universal
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...
Helpful - 1
Avatar universal
i have 3weeks into post op distal urethroplasty..follow up in january.
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Avatar universal
I have had urtheroplasty 3 years back but that was for bulbar area. the current one is for front part and been told the stricture is around 5 cm
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Avatar universal
Hi, I have a upcoming urthroplasty surgery .Doc is saying it is  2 stage and the second one is done after 3 months.Has anyone gone through this procedure and would be kind enough to share their experiences?
Helpful - 0
Avatar universal
Hello, I'm 26 and currently am on day 10 of recovery. I was hoping to maybe get some advice as to why and how to reduce night time erections?? These are horrible. Mine is at a 90 degree angle hard and hurts like hell. Will this correct its self? I had a stricture from tip (meatus) to 4.5 inches inwards. Buccal mucosa Urethraplasty is the surgery I had. Best luck to everyone who has to have the operation. It's not all that bad. Just the boners at night, ouch... I've maybe gotten 10 hours of sleep out of the last 10 days due to them. HELP PLEASE!!!!
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Avatar universal
I had it done 3 weeks ago the Foley removed yes today 3/8/16 after it was removed and I went home I am having Uren leaking is this normal???? If so how long will that last???? i didnt speak to my doc. yet
Helpful - 0
1 Comments
Definitely advise your dr
Avatar universal
Hi, who did you see in Bristol, my 19 year old son has his urethroplasty booked in for 10 days time, we have been referred from Devon to Mr Dickerson who operates out of Bristol and Weston Super mare and I must admit he can be a little abrupt! I hope yr partner is now sorted a year later???
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Avatar universal
Thank you. Who is your doctor if you don't mind sharing
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Avatar universal
Thank you. This is great help. Mine will be coming up soon
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Avatar universal
To anyone that can offer advice or help in the UK, please see above message to Zoltan, just in case he doesn't come on here anymore. Any one that has any advice would be much appreciated. Thanks
Helpful - 0
1 Comments
hi deetosca,did you go for surgery?
Avatar universal
Hi Zoltan, I hope you can put my partners mind at rest, he needs this op, we are in Bristol and my partner has been having urethral stetches for the last 10 years, he was blocked from getting a second opinion for Urethroplasty in 2006 by his urologist because the surgeon said it couldn't be done, we saw a different specialist today who was to say the least, hostile and aggressive, made us feel very uncomfortable and we couldn't get out of his office fast enough, only shame is we have to pay for his time as it was a private consultation, we have read your posts and are thinking of seeing Mr Watkins,is he friendly and approachable, any help would be very welcome.  Thanks.
Helpful - 0
Avatar universal
Hello,
I just had a buccal mucosa urethroplasty done on February 26. I have not had much pain but have not had an erection since the surgery. Prior to the surgery the doctor told me he thought the stricture was 2cm but after the surgery I found out it was 3 cm. I have looked for numerous articles for long term success for this procedure but I have not found anything. To me long term is 20 years not 3 to 5 years. Any feedback on this would be greatly appreciated. I hope I have made the right choice in having this procedure done.
Helpful - 0
Avatar universal
Hello,

I have undergone bmg urethroplasty 3 days ago, the two stage procedure, for an anterior stricture ~ 4 cm in length. After reading all the comments here and on other sites i must say that i was a bit worried about the recovery. Surgery went well, the doctor removed a big chunk of bm from my right cheek to replace the the affected area. In the recovery room i didn't experience any real pain, not in the penis or in the mouth. The sensation was more like discomfort in the mouth but nothing to do with pain. Next morning the doctor let me go home and i will have to return after 7 days to remove the catheter. I spent the first day home mostly in bed, drinking liquids, watching tv and sleeping. Sleeping is the hardest part because of nocturnal erections and that is the only time when i experienced some kind of pain. In the second day i was feeling much better, went outside for a 1hr walk and did a bit office work. Today i'm feeling much better overall, my inner cheek is healing fast and i can drink and eat almost normally. I want to resume work and to spend some time outside. Even if i'm only three days after the 1st stage procedure, i feel very optimistic and confident about the final outcome.
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Avatar universal
Just wanted to share my experiences real quick.  I was first diagnosed with a stricture around 2006, but looking back have probably had it most of my life.  For the most part, it never got bad till after my first dilation.  The second time I was dilated by that uro, I was sitting on the toilet after and bleeding profusely, feeling like I was about to pass out, when someone came in and informed me they needed the room for the next patient and I needed to get out.  I never went back.  The next time I had issues, I did my research and landed on Swedish Urology Group in Seattle, specifically Dr. Kuan.  My first visit he wanted to scope me, and I was terrified after the painful experiences I'd had previously.  He finally convinced me and, to my surprise, it didn't hurt a bit.  We went through several years of management, with multiple dilations, a urethrotomy, and self-catheterization (which I was admittedly terrible about following through on... ain't nobody got time for that).  Finally, he performed a urethroplasty with a 5cm buccal graft on me.  When I woke up, my first thought was "my arm hurts!" due to how it had been positioned during surgery.  My mouth and perineum were a bit sore, but not too badly.  My only pain meds were tylenol in the hospital and ibuprofen at home, 200mg 3-4 times/day.

The worst post-op pain I had was 3 days later when I had my first post-op bowel movement... I probably should've taken some stool softener, but I didn't.  Felt like I was gonna bust a suture, but I survived.  I was sent home with a 20Fr Foley, which I had removed 13 days after surgery.  First uroflow, I hit 40ml/s, and I think things have improved since then after the remaining blood and such got flushed from my system.  So, just a couple weeks after surgery, I have great flow, no pain on voiding.  My only issues are some ongoing tenderness and swelling near the incision, and that it feels completely different to pee... mostly, I don't feel it at all.  I also seem to have slightly reduced feeling in my penis, though that may simply be from swelling around the nerves.  It's not severe, and if I had known the full outcome before hand it would not for one second have stopped me from having the procedure done.  We'll see what the long term results are, but so far I'm quite happy.

Hope this helps someone!  If you're in the Seattle area, I can strongly recommend Dr. Kuan and Swedish Urology Group.
Helpful - 0
Avatar universal
Thanks for posting your experience. It gives me some confidence.
I had a stricture 18 years ago that was treated once with dilation- sadly I've been getting numerous bouts of prostatitis and uti's in last couple of years and I'm now in a lot of pain- my urologists thinks the stricture has returned- if this is the case I'm going to set forth with urethraplasty - I don't see the point of any of the alternative treatments- I want it cured. Having gone 16 years with no problems I can't believe the stricture came back......I'd have another dilation if I thought it would last that long again but my fear is that it will return much quicker this time.
Helpful - 0
Avatar universal
Interestingly, K2, Acetyl-Carnitine, Lysine, C and E and I have improved a bit.  It is rare over last few days that there is any difficulty in getting flowed started, sitting or standing.  Still usually a 5-10 second pause before, but painless and no exertion.  However, I find two symptoms persist:
1) the easier it is to get the flow started, the more it goes 35-degree angle left (didn't have this before these symptoms started).  I wonder if this means that scar tissue on right side is maturing/hardening.  When it's sensitive/difficult, this is because it is trying to pee through where the scar tissue is (have felt as thought it was always more on right side).
2) Dribbling.  75-90% of the time there are 2+ drops.  This is after waiting to empty a little bit after initial flow stops...there is a combined finger in butt + kegel to get a little more pee out.  This is almost always completely painless, sometimes a little mild discomfort but I feel getting better (although this also maybe means scar tissue hardening/maturing).  But after doing this, 1-3 minutes after, always 2-4 drops.  Just a little bit, but still annoying.  I can tell when this is happening too, as soon as I pull up my pants, I know a little urine stick in penis.

I suppose, additionally the underside is not great.  Little semi-hard natural colored bump about 1/2 inch down from tip, painless.  Had this for mb 4-5 years.  Under this, about 1 inch from top, cross shaped white nerve, thinking lymphocele?  

And under that, generally red and sore - this always been fairly mediocre, partly due to bad hygiene and bad/rough masturbation habits.  Once I had symptoms 1 year ago, I started to wear boxer briefs exclusively for the first time since age 13, I had been exclusively wearing boxers.  Helped with a securing feeling, but **** always stuck to balls.  Made for difficult peeing bc scared to unstick, bad masturbation habits (often in tight boxer briefs, constricted erection and ejaculation and not changing underwear, many times daily after symptoms appeared...not good for healing in a way that would prevent scar tissue), and general redness/diaper-like irritation.  Was using desitin, seemed mildly helpful.  Since switched to Lanolin w/petroleum Jelly.  That + supplements + NON-KEGEL, CPPS-oriented PT exercises (Amy Stein) seem to be helping.  Difficult to tell which of 3 since all started around same time.

Anyway thanks for some feedback...
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Avatar universal
I'm going to keep posting here.  Don't really care if anyone else is, but it would be nice to get their input.  I started taking vitamin k2 and lysine, as well as back to acetyl carnitine after a month off.  I noticed improvement, although perhaps some deterioration today (3rd day).  My thinking with k2 was that k2 helos metabolize calcium correctly, removing it from soft tissues and ensuring it goes to bones and teeth.  Since calcium was key for scar tissue, I was hoping the k2 would help.  My underside remains sore (neg for infection/blood/protein/everything on many urinalyses).  Penile cancer obviously first concern.  Will rule out std's like herpes for underside on 10/3.  I also noticed my right testicle is quite swollen - no lump, and no pain, but it is v large, more than normal.  Or this has something to do with the fact that no orgasm for 58 days?

Anyway there are many questions above and it would be rgeat to get some input from other users.
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Avatar universal
This is very similar to my symptoms.  It can be very annoying how often posts here go unanswered, or how cursory the responses from the MD's that do bother to respond often are.

http://www.medhelp.org/posts/Mens-Health/Painful-Urination-Ejaculation-Erection-and-swollen-dorsal/show/1506900

Last few times urinating, I have to kind of flex my kegel muscles to pinch and get it started.  Afterwards flows normally.  Little post-void residual dealt with effectively by putting a finger in my rectum slightly which causes natural reflex action that painlessly, effortlessly gets rid of that residual.  But starting urination is a pain (and this feeling seems to occur even if my **** is not stuck to my balls).

I was on alpha blocker for 7+ months.  I feel like a side effect of the med (been off for 3.5 months but there are plenty of documented cases of people who feel as though the sides don't disappear even after a very long time) is that my muscles/nerves have kind of forgotten how to relax to void.  Anyone who was on flomax and could share, that would be helpful as well.  In the end I think I will just have to go Gelman and get a high-skill cystoscopy.  I wish one could get more substance from this site.
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Avatar universal
Thats good to know.  I live in DC so VA beach would be closer than Irvine, CA but Gelman seems to be the best so I think I will fly out.  Also, he stresses that he is aware that a cysto can cause further trauma and he knows how to cysto without worsening the stricture.  4 Uro's in DC area told me - there is infinitely, virtually no risk of any worsening trauma from doing cysto - something Gelman confirmed is COMPLETELY WRONG.  If a uro responds that way, run and find someone else.

Also - re: stricture in first place (I've not yet actually been diagnosed) - can it be stricture if the symptoms seem to come and go?  Sometimes it seems like crap getting started, like it's pushing through a very narrowed urethra.  Other times, it feels completely normal.  Does this rule out stricture at all?  Could it be stricture, and it's just starting to narrow to the point that it's problematic for the first time, hence why sometimes its ok?

Also - important: I started wearing boxer briefs as opposed to boxers for the first time since I was very young, after I developed these symptoms, because I feel that the added support helps with comfort.  However, my **** sticks to my balls way more.  A general (clueless) male question (kind of trying to come up with alternative explanations to stricture) is then: do guys find that if they do not "unstick" their **** from their balls, that this makes starting urination more difficult?  Trying to determine if this could be a cause/aggravating part of my symptoms, as opposed to stricture.  Maybe my **** is just always stuck to my balls, and this is why it's so hard to pee (I've been so paranoid about stricture and the pain in general that I avoid using my hand to guide/unstick my penis).

Thank you for anyone that can share their experiences.
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Avatar universal
Dr. Mccammon in virginia beach is very good. Had mine done almost 3 years ago with no problems since.  Insurance did cover all of it.
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Avatar universal
"how is it good at it" lol I meant "who is good at it"
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Avatar universal
It is indeed impossible to find a listing of how is it good at it int he US.  I believe this is because it is so high-skill, so many uro's SUCK at it, so they are threatened by it and still recommend stent and incision.

Joel Gelman at UC Irvine (Center for Reconstructive Urology) is excellent.  I know of no one else.

Does anyone know how much it costs?  I'm guessing insurance won't cover a penny.

Also - was everyone here diagnosed with a cystoscopy?  Isn't there a risk that cysto worsens/causes stricture itself?  I'd like an alternative diagnostic procedure.

Thank you, I hope people still visit here.  Really bad lack of/misinformation on this on the internet.
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Avatar universal
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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Avatar universal
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 ....
Helpful - 0
1 Comments
hi ajju, did you go for surgery?how was your recovery.
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