Scar tissue at tip of penis, use of spigot to dilate

Hi the bladder neck incision went ok, its the scar tissue from the catheter that caused the blockage. I'm really interested to hear from anyone who like me has/had to self dilate each day, not with a catheter fully into the bladder, but as i said a plastic spigot (in my case) to insert about 15mm into the tip of the penis. Thanks

Hello Shaun

I'm sorry to hear about the problems you are currently having and can relate to them quite definitively.  I had a urethra widening mini -TURP and a BNI in February.  Urinating was made easier for nearly three days only,  by way of the procedural dilation.  But then almost immediately thereafter,  I developed a stricture about 10mm long at the distal end of the urethra.( I e  near the penis tip ) that sent my urine all over the place as flow waxed and waned during voiding.  A most demeaning experience but one which with a little ingenuity I learned to manage hygienically.  Being a Public Pt. I naturally had to wait to see my Urologist but after dilating me he provided me with a spigot.  Actually a few of them because they come attached to a syringe of Lignocaine.  What I was instructed to do is insert the end of the syringe and inject a small amount into the urethra. This dulls the pain and then I can apply the spigot as a dilator for about 15 seconds. I find this to be a useful ongoing management procedure but it needs to be practiced almost daily as its therapeutic effect quickly wears off. 

Carrying it out without Lignocaine however is I know,  a severely painful, debilitating and counterproductive experience.

Regards

Dudley

Hi thanks Dudley. I've been provided with some instilligel to apply to the spigot. How far do you push it in? I'm worried I might be going in too far? Also what is the prognosis in your case, are you likely to have to continue to self dilate every day for the foreseeable future?? 

Hello Shaun,

How's it going?  I push my spigot in about 15mm and this creates, because of the broad taper,  an opening of about 8mm to 10mm at the tip. I do not try the procedure without first applying a v small amount of lignocaine gel to the urethra from the plastic syringe,  which itself is about 2mm wide and goes into the urethra about 8mm.  Anything less and the gel will not bi-pass my obstruction into my urethra.

In my case I think daily would be too much and less than twice a week too little.

Hi, Shaun I am performing self dilate each day, I was operated twice VIU for stricture, and my urologist asked me to do it every day.

Hi what size do you use? Mine is only FR10...

Hi I've no idea how wide the spigot is, I was a bit worried as it seemed to me like I had been given a basic plastic thing, and not designed for this!! Hence my concern re bleeding, although it isn'tt a lot of blood admittedly. 

I can't imagine having to put a catheter into the bladder every day, I had horrendous trouble at hospital because the Dr couldn't get one into me! 

Hello Shaun,  I can also relate to the  ' difficult access '  scenario.  The distal end of my urethra was unfortunately traumatised when my Urologist inserted the gold seeds into my Prostate Tumour for the Radiology Team to aim at.  I think like your goodself my urethra also must be at the narrow end of the scale,  because the equipment he used to insert the seeds was one-sized only and my Urologist apologised a couple of times as he struggled repeatedly to push in the tube with two Nurses assisting,  who actually winced visibly and later,  commented upon my ' bravery '.   Brave?   Well,  what option did  I have.?   Suffice to say, that during the protracted process, I was as rigid as a post and galvanised as if holding a bare electric cable !  And a fair bit sweaty.

You've asked about my prognosis ?  Well, just yesterday,  I had an operation to remove a small tumour from the distal end of my urethra.  ( apparently in certain instances the urethra can throw up a tumour subsequent to trauma,   and in my case it did so .  But I hope not in yours.).  

I've had a few GA's in the last five years and so this time was given,  very expertly,  a spinal anaesthestic. Catheterised overnight. Very little bleeding and allowed home this morning.  

Again unfortunately,  the treatment of strictures is by way of their aetiology,  life-long.  The gel should enable you to gently and cautiously insert a tapered spigot to create an opening 8-10mm wide at the tip.

Hi Dudley well I managed to self dilate until early January when I found I could no longer get the spigot in far enough. I went to see the consultant on 16th Jan who said to stop trying in case I damaged things further. Since then the flow has considerably reduced, to a slow thin stream. It's painful now too, and takes forever to void, sitting down is the only way. I'm seeing the consultnt again on Thursday, but I'm worried as I think he will just say I need another dilatation. Its only been 2 months since I last had this done, and I've read that repeated dilatations can make the scarring worse in the long run. Do you know if there are any other solutions to scar tissue in the distal region? I'm feeling pretty down about this as everything I read suggests there is no cure, just management of the stricture. Cheers, shaun

Hi there Shaun.  I'm sorry to learn that things have presently got tougher for you rather than easier.   But try not to despair.  Hopefully your Consultant can come up with something positive and curative.

in the meantime,  the only management tricks I discovered are ...( if only this wasn't so damned Pulic and embarrassing )  ...  : 1) whist seated,  lift up your stomach in the region above the pubic bone and below the navel.  This can also be done standing.  2) don't abandon the effort to pass water, if the circumstances are not pressing.  Although you may have diminished sensation, there can still be an almost imperceptible flow.  And I reckon that every drop out is one less in and the risk of infection thereby lessened.  3) at the end of a bath you can try and relax and let the bladder empty. A 2 ltr jug can then be mixed to sluice off as needed.  A disinfectant/ bleach such as Domestos then keeps everything sweet.  Same applies to showering. 4). At night I have an empty sterile capped 2 ltr container which I use as needed. This process need not disturb your Partner . All necessary hygiene precautions are taken in the a.m.  I use this method during the day if I'm having a particularly bad time. 5) if you have time to do it,  try stretching out your penis by holding what's left after circumcision and pulling gently but firmly and holding for 5-10 seconds with one or two repeats.  This actually works. If you are un-C,  it should be easier. 6) a warm hot water botel placed below abdomen is also helpful 7) hydrate well.

thats all I know.

Good luck Shaun,  hopefully some of the above will help.  I am now going to hiang my head in shame realising that my humiliations are now public and floating around the Universe in cyberspace forever.  

But then I think. - - - - it,  it's not my fault !

 

Oh yes,  I meant to tell you :  the Indian Journal of Urology has an excellent article on the surgical management of strictures posted on line.

The article is :  ' Buccal mucosa urethroplasty for adult urethral strictures ' .

Hi well I've now had a urethrotomy, although the consultant also mentioned meatoplasty on my notes...it's certainly done the trick in terms of improved flow, and now only a small leakage afterwards. According to the consultant I have a small stricture less than 0.5cm near to the tip, but it was enough to cause the symptoms..he has given me a weeks worth of speedicath compact plus, to self dilate each day. They are not very big, only CH/FR 10. I am wondering if (a) they are big enough and (b) whether a week is sufficient? Most of what I have read on here suggests the need to do this over a much longer period! Any thoughts anyone on this? Has anyone had no stricture recurrence after a first urethotomy? 

Hi Shaun,  I'm glad things have improved for you.  Regarding cath sizes,  I'd say that you've been given,  what is right for you now.

Strictures can and do reoccur.  Hopefully yours won't.  

Anyone else's subsequent experience can have absolutely no bearing,  on yours.

I would respectfully suggest it is time now rather,  to give thanks for the relief you have obtained,  to stop worrying and to stop trying to guess the future.

Live a bit.

Regards

Dudley 

Yes you are right Dudley! I will try...

Best wishes

Shaun

Hi Shaun, Just wondering how your urethrotomy is working out. I have the exact same issue you are having. My scar tissue is from a foley catheter after prostate surgery. I am self dialating twice a day right now for a couple of months and the Dr. said if that doesnt work then he would do a urethrotomy. Was this procedure done in a hospital or in the office. Did they put you out or give you a local. Just wondering what I have to look forward to.

Art

Hi Art

Well basically i had my 2nd urethrotomy on 4th June, at the local hospital. I was put under (GA) again this time and overall the Op was very straightforward. I was discharged the same evening. My consultant said that the scar tissue was less this time which was positive, but that i should not self dilate post Op on this occasion, as he wanted to see if things settle down. So far so good, although over the past week I have started to feel a little resistance when I pee. I'm worried it might be growing back again, which is definately not what i want!! The consultant had said that if this happens again, i may need to have a urethoplasty. Obviously this is a much bigger deal, and I've read about some of the side effects which, particularly at my age (45), is worrying to say the least. Although its also said that Urethoplasty has a much higher success rate.I would discuss success rate of urethrotomy with your Dr too. Best of luck!

Shaun