Hi. I am a 34-year-old male in the US and stumbled upon...
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Hi. I am a 34-year-old male in the US and stumbled upon this site as I was looking for some information regarding the effect of having erections with a catheter inserted after having a buccal mucosa skin graft urethroplasty. I found the site and stories so interesting that I thought that I would share my story.
I was diagnosed with a urethral stricture about 17 years ago. I will not get into too great of detail but I underwent some dialations early on and then had a laser incision done on the stricture to try and remedy things which was unsuccessful. This laser incision was done years ago not long after the initial diagnosis and following that it was a series of dialations. I moved around a lot and saw a lot of urologists. We tlaked about stents. We talked about open surgeries. I probably was dialated five or six times a year. Had times that things totally closed up and had to have catheters inserted. Ugh.
Finally my urologist put me in contact with another urologist that had done some urethroplasties. This doctor said that we should have done the urethroplasty years ago. We bit the bullet. Anyway, we made the appointment and we did it. I am currently laying on the couch in recovery. Here's how things went so far.
I had the urethroplasty done on January 3rd. The doctor explained that they would make an incision between my penis and anus and then first try and cut the stricture and tie the ends together if it were possible and if not then they would move to the idea of removing the stricture and reconstructing the urethra using skin from inside my mouth. This is called a buccal mucosa graft. As a preparation the doctor gave me some "Swish and Spit" to use before and after to help keep my mouth clean. When I woke up in recovery after the anesthesia wore off I knew which option had been used. They had taken skin from inside my cheek. Coming out of anesthesia I felt like I needed to vomit a few times. Once that wore off I was just really cold and sleepy. I stayed over for one night in the hospital. There was some dull pain where the incision was but the worst pain was the inside of my mouth. It is hard to believe how painful that area can be and how slowly it will heal.
Anyway, I left the hospital and returned home. I was given prescriptions for four medications. 1. Vicodin - Very helpful in mouth and incision (mainly mouth) pain relief (took lots of this) 2. Stool softener (took a little of this) 3. Bladder spasm calmer (never needed this) 4. Antibiotic to be taken 2 days prior to follow-up visit. I still had the "Swish and Spit" which burned but helped my mouth heal. For the first day or so I was in a haze at home. It was a combination of the anesthesia and the vicodin that I was taking. During the next week the mouth pain was awful. All other pain was minimal. I have been surprised at how little the incision has been painful. Many speak of issues related to dealing with a catheter. Maybe it's my past experience (I've had many) but the catheter bothers me little. The worst part is when I get erections with the catheter in place. I've wondered what affect those have on the skin graft.
After two weeks or so there is very little pain anywhere. My mouth pain is very minimal. I can feel the smooth healing skin in my mouth with my tongue. The incision gives me little trouble. There is still a bit of scrotum swelling. I should mention that, as others have mentioned, the scrotum will be enormous after the surgery but over time the swelling will subside.
I have nine days left of the catheter being in. I will start the antibiotics two days before. When I go for the follow-up they will remove the catheter and do some X-rays similar to the ones that they did prior to the surgery to take a look at the location of the stricture. It's amazing in the pre-operative x-rays how narrow that opening really can get with a stricture.
One thing that should be mentioned is the importance of keeping the incision area as clean as possible given that it is so near to the anus and that bowel movements could introduce some adverse conditions. Bowel movements with catheters in place are interesting in the first place. You may anticipate some anal swelling.
It will be then that we will get the first inkling of the success or failure of the long-awaited surgery. I feel very confident that things went well. I guess we'll see.
[i:e97c2d7cdd]This message was automatically imported from the original Patient Experience[/i:e97c2d7cdd]
2 likes, 51 replies
bootit Guest
Posted
No pain as balls and penis swollen and numb. 4 hours later still numb when pain killers wear off hence still no pain.
Catheter through penis and small tube connected to larger one then into large bag attached to side of bed. Bloody urine that requires lots of drinking to get it clear. Need 3 large jugs over the next 12 hours.
No stomach catheter as simple join with no graft is not a big infection risk so standard catheter through penis 2 weeks.
Tape between scrotum and anus where incision was stiched. A strange blood drain container about the size of small cup collects blood from wound. This dangles about and careful not to sit on it. This is what they look at to discharge you if the bleeding stopped.
To make surgery optimal drink hourly a large cup water prior to the fasting time. Get hydrated as after surgery you can be dehydrated making recovery slower and causes feintingif stand up.
Take some stool softener with your last meal and some osmotic laxative each evening 2 days prior as the morpheme will constipated you.
bootit
Posted
The catheter in a male sits under the balls and you can feel the tube. It is the thing that makes you feel uncomfortable when you sit on it for a while.
You need to clean the catheter with iodine based antispetic on the eye of your penis and the cathetete tube. Dont be afraid to pull it out about 2 cm for a clean. Its stuck in and wont come out. Otherwise it will get crusty and painful.
The catheter bag is a pain and as it fills then under weight slips down your leg. You seem to constantly empty it as it holds about 600ml. Surgical review at day 7.
bootit
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Itsrusty Guest
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Tinbiz1976 Guest
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Have not been told much as to how long recovery may be? I do know they are planning more than one procedure.
Can anyone suggest how long I may be off work for?
I am attempting to discuss with the specialist prior to Friday, but they're not easy to get hold of!
I walk all day in my job if this helps advise me.
Itsrusty Tinbiz1976
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Tinbiz1976 Itsrusty
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Did you have the skin graft also?
So I'm likely to return to work on light duties after about 4 weeks maybe? Or what do you think? I'm a postie, so do not have toilet access easily!
Itsrusty Tinbiz1976
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Tinbiz1976 Itsrusty
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I'll let you know how I get on in a weeks time.......
Itsrusty Tinbiz1976
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Tinbiz1976 Guest
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The operation appears to have gone well, and has been completed in one procedure.
My "bell end" was opened to allow skin from my mouth to replace the end of the urethra. I've been told its all been closed back up again, but am unsure as I haven't been able to see for myself yet!
I have very little pain and my mouth is giving me more trouble than my wiener. I have stitching in my mouth and it's quite swollen, but I have still been able to eat ok.
I have a catheter fitted and am due to have this taken out in ten days. The biggest problem I am facing is removing the dressings, which have been taped to my body with thick tape! I may have to gently cut it off with scissors after a soak in the bath.
All in all I'm doing ok and looking forward to seeing if it has worked! I'm expected to be returning to work within a month.
Tinbiz1976 Guest
Posted
My mouth is still a little numb and swollen from the skin removed and not sure what's ha with the stitches. Seeing district nurse Tuesday who will look at them and remove the catheter.
The ballon in my bladder is irritating and causing some blood in my urine if I do too much walking about.
I've had little pain from my wiener, more just uncomfortable because of the catheter. I Hope it's all healed inside correctly so it won't sting too much when I attempt to pee again!
OZpatient Guest
Posted
Finally got the courage/need to have the graft done. Surgery took 4 hours and graft taken from inside my cheek. Overal experience much much less unpleasant that i imagined.
No real pain to speak of at all - apart from a little bit in the first 24-48 hours. Naturally also sore in the incisson for a couple of weeks.But generally really not a big issue. Catheter in for 3 weeks is a nusicance - but not really more than that when you take care to strap your penis up tight enough for it not to move around.
Cathether out 3 days ago and all seems fine - great flow and really not pain still. naturally not out of the woods yet and need follow up in 3 mths time to ensure the urethra is not restricturing, however all signs are good. Should have done this years ago!
One important thing though is to make sure that the surgey is only performed by and absolute specialist in this area. It is a highly specialised operation and even though it can be performed by many urologist - it is very few that can perform it well. Only a couple of guys here in Australia who can do it it.... so do your homework before going under the knife.
peter_38663 OZpatient
Posted
I have been suffering same problem like you last 8 years. I am planning to go for the surgery now. Could you please let me know whom you have done surgery in Australia. I will be very grateful to you if you can help me to find out right doctor. Waiting for your reply. Thanks
rhys75236 Guest
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At 21 days the catheter was removed and the results were almost instant. No pain or anything. I even walked home, very carefully, nearly 3 miles from the hospital, straight after the catheter was removed.
There have been up's and down's since. But it's mainly down to paranoia and worrying. I go through stages where the flow is bad again, or I'm constantly needing to eurinate (like the old days). But I am convinced that coffee really does make it worse. In fact I think it's certain types of coffee. Struggling to give up. But I can have a day or two worrying about it and then I'll go and the flow is currently great again.
I discovered pelvic floor exercises are a great idea! But I forget to do them until the flow or sudden urge is bad again. And training myself to hold it in for at least 15 minutes when I get the urge is good apparently - to train the bladder into behaving normally again.
What I struggled with was having to give up road cycling (and exercise for the first few months). It's nearly winter now so I'm giving it longer to get cycling again. But for the last two weeks I have been to the gym and lifted heavy weight on my legs. Before that I was leaving my legs out of training. But all feels ok when I'm doing it so I fugure it's ok. Not lifting as heavy as before the op. And also subsituted cycling with swimming.
However, I've got a constant sharp pain in my stomach, for the last few days. And the flow has been on-off again for the same period. Hoping it's not related. And I don't think it is. But does anyone have any experience of it?
mwashbu rhys75236
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Thanks for your openess in describing the procedure and your issues during recovery. Like you. I'm a cyclist and saw a urethroplasty specialist after having a UTI that triggered my urethral stricture to clamp doen to the point where I almost couldn't void. Luckily, I had an ER resident that was able to get filliform followers through the stricture to the point that he got a 16 Fr Floey cather in place. It was taken out yesterday and I feel like a new man. Interestingly, my urologist doesn't want me to self-cath until the imaging follow-up in about a month. She also put no restrictions on my cycling,especially since I showed up to the appointment with a newly purchased SMP Pro saddle with a huge cutout. I had been using Koobi saddles on my bikes ffor about 10+ years but the channel in those saddles is nothing compared to the SMP Pro. My main questions for you are 1) how long you're supposed to refrain from cycling post-surgery (i was told a year of no cycling), 2) what replacement exercises can replace road cycling (recumbent or elliptical stationary cycling?), 3) whether you've started cycling again since your last post and, if so, what saddle you used, 4) whether you experienced pain in the surgical area if you've returned to cycling and 5) any other suggestions you've got for a fellow cyclist. Did you experience as much residual pain as others have reported for mouth skin removal? I'm guessing that I'll need a buccal muccosal graft based on what I've seen during past cystoscopies. I'll know for sure in a few weeks with the inaging studies. Thanks in advance for any help that you can provide.
rhys75236 mwashbu
Posted
I didn't experience the catheter being fitted as it was done during my operation (and I hadn't needed a catheter previously) so I'm fully sympathising with you on your experiences. My surgeon insisted the op was necessary to avoid problems in future (and believe me I double checked, even while I was in the pre-surgery prep area) as it was likely I would get UTI's as I got older and then find it difficult to clear them due to the stricture. So I guess this is where you are - starting to have the UTI's and needing the op.
I had no pain whatsoever in my mouth. The graft was taken from the inner cheek area on the right hand side just where my teeth bite together. I'd almost forgotten that's what the surgeon was going to do (or thought that they hadn't in fact needed it after seeing my stricture in the flesh - which they said could happen). But they did indeed take the graft. The first I was really aware of it is when I went to eat some food in the evening after the op. I went to bite into a good old NHS sandwich and all I can explain what then happened is a 'snap' in my cheek - I assume it was some scarring or dried blood breaking as I'd opened my mouth as wide as normal to shovel down my food. It was only a slight shock and I remember no real pain with that. But I did eat very carefully and slowly thereafter for a few days! I'd too read some scary things about it possibly getting infected etc. So I insisted on mouthwash which I kept having to remind the nurses/chemist for - I therefore don't think it was necessary. The mouthwash they gave me was just a good quality high street branded mouth wash - so I could have taken my own into hospital I guess!
Here's my answers to your questions (only based on my experience of course)...
1) how long you're supposed to refrain from cycling post-surgery.
My surgeon said to refrain for six months. And to then start carefully with a very padded saddle. When I explained that I was more a road cyclist and go at it a bit more extreme than that then he was a little doubtful. While now I look back at the op and think it wasn't as bad as I thought it was going to be, mainly because the time has gone so quickly, it is still one major op!! I think I was on the table some 4-5 hours. The psychological effects of being so fit and healthy to then having this op and being unfit for work for up to eight weeks were difficult, for me. I didn't want to be going through any of this again, ever. So I imposed my own 12 month break from cycling - my partner thought that was over the top but I wanted to be totally sure. As the registrar pointed out, that mainly covered the Winter period anyway which made me feel better. In December 2015 (month 10 post-op) I was on holiday in the Canary Islands and had a Eureka moment. I just had a very clear feeling I was ready to get back to cycling. I know the guy did it with a lot of pharmaceutical assistance but I thought that if Lance Armstrong could do what he did with lobbed off testes (and I'm assuming that whole area sat on the saddle would have been a similar sore situation) then I thought I could do it too.
After my holiday I started on an old spin bike at my gym. I actually went back at it quite extreme and had some very sweaty sessions but had no real pain afterwards, possibly just a little saddle soreness and wobbly walking afterwards.
By the time I bought a new bike and waited for some bad Welsh weather to clear it was early Feb 2016 (month 11 or 12) before I was back on the road! And I started with a little local 11 mile ride.
2) what replacement exercises can replace road cycling (recumbent or elliptical stationary cycling?).
I wish I could have cut back on the food a little more while I was less active. But by month 3 or 4 exercise was becoming NECESSARY. So I went with the registrar's recommendation of swimming. I swam as a kid anyway and wanted to build up my stamina again, so I got a swim membership at my local pool and did that 3-4 days a week (still do it but less often), aiming to do a mile in as close to 30 minutes as I could. I'd recommend swimming for sure! I didn't do anything that would be too extreme in that area. I didn't try a class at the gym until around the end of January. But walking everywhere wasn't a problem - even in the early days with catheter it's surprising what you can do if you do it slowly and carefully. I think I was being careful bending down, refraining from lifting anything heavy even in month 3 and 4. I really don't want another op!
3) whether you've started cycling again since your last post and, if so, what saddle you used.
Just before the op I showed the surgeon a picture of the "Adamo - Attack" saddle. But he wasn't sure he could confirm whether it would be any good - sort of suggesting that we're all different and there were too many variables involved. The registrar afterwards, some weeks after the op, wasn't too sure either - just suggested 'it might help'.
I bought a new 2016 range Trek Madone 4.5 or thereabouts as I always intended to get a swanky bike. And I figured I deserved it. I've gone with not getting the Adamo saddle and just going with the saddle that came with the bike. It actually has a little of the middle of it missing so I figured it was better than a standard solid saddle. It seems to be going ok. Not the prettiest of saddles but it's ok. I need to adjust my saddle height and try it higher so will report back. But I haven't ruled out getting a different one yet and will be googling the one you talked about. See below re saddle soreness...
4) whether you experienced pain in the surgical area if you've returned to cycling
Not really. When I first got back into cycling a few years ago after a LONG break I remember having saddle soreness in the perineum for a couple of rides and then seemed to become immune. I don't know whether the damage caused to the pelvic floor during the op has made it more sensitive but I seem to still be a little sore still, some four weeks in. I'm doing up to 52 mile rides at the moment so am almost fully back into it. I've been surprised I'm still sore. But then I've been surprised at how you need to keep up the pelvic floor exercises to keep things regular. So perhaps that muscle really has gone through the wars!
5) any other suggestions you've got for a fellow cyclist
As my surgeon hinted at, all this is a little bit 'finger in the air' as there isn't an awful lot of info around on it. So my approach is finger in the air too and I hope that what I'm doing now isn't causing any harm. I should in theory be seeing the registrar or surgeon soon, at month 12 or so. I'm hoping, begrudgingly, they'll do another urethrogram to check the stricture isn't coming back. I'll report back here!
I by no means sat and did nothing during recovery. I did some things too early, like trying to drive around and do some work for my boss at day 7 (big uncomfortable stressful mistake), cleaning the whole house and trimming back an overgrown garden at my mother's house a couple of weeks in. But I'd like to think I trusted my instincts. I wish I'd pushed myself a little more with the swimming and that I'd been more careful and cut back the amount of food I ate - but it's done me no real harm and any excess weight is disappearing again now. If I was an absolute dedicated professional athlete I'd have probably gone back to cycling earlier. But I'm happy with the way I've done it, so far, and Winter worked in my favour.
Hope this helps. Sorry I'm a wordy writer.
I might have some saddle questions for you after I've done some research...
rhys75236 mwashbu
Posted
mwashbu rhys75236
Posted
I was somewhat surprised by what she told me to do after the catheter came out, which was not to self-cath at all and get back on the bike so that she can try to get the stricture to return to its pre-dilation length and diameter. Even though I live on the West coast, I've used Merlin Cycles in the UK a few times and that's where I got my Selle SMP Pro from (about $100 less than anywhere in the States and no tax and free delivery). I actually took it to the urology appointment and my doc said that's the exact one she'd recommend. I'll give it a maiden voyage tomorrow. The Selle Italia SLR Superflow 145 has a massive cutout without the drooping nose on the SMP saddles. The Selle Italia SLR Superflow 130 saddle is narrower and the cutout looks even bigger. I've been riding Koobi saddles exclusively for the past 15 or so years and the groove that runs the length of the saddle doesn't even come close to the cutout sizes on the Selle Italia saddles.
I'll be going into the stricture imaging appointment with an even more open mind thanks to your comments. I really appreciate you taking the time to respond and will update the post once I've gone through the surgery. It will be a great relief to not have to deal with self-cathing and periodic urethrostomies (or as they call them here "DVIUs"). Thanks again.
Mark
rhys75236 mwashbu
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What you are saying is music to my ears. Very lucky indeed that you got a cycling Urologist!! Perfect. She needs marrying... I was a bit lost on whether to change my saddle, but with your specific advice I'm going to do it. Thank you!!!
What does she say about whether cycling causes any of this? I'm pretty sure I've always had this stricture. But then I practically lived on a bike when I was a little lad, so could have had a cross bar accident when young for all I know. I was wondering if sitting on a saddle the size of a peanut actually makes anything worse... Has she said?
Rhys
rhys75236 mwashbu
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mwashbu rhys75236
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I'm sure that mine was cycling-related, especially because I got heavily into mountain binking in the mid- to late'80s before there was any suspension. I really regret spending so much time seated knowing what I know now.
Selle SMP claims that all the features on their saddles are designed for biomechanical benefit. I think I saw on their site suggestions to make small saddle angle changes in order to benefit most from the design. One of the women that reports to me used to use a Selle SMP saddle and said that it definiteltook some getting used to. She said that when the padding on the inside edge of the cutout began to break down, that caused some discomfort. Some of their saddles seem counterintuitive since they have big cutouts but lttle or no padding. I chose one that had a decent amount of padding and was closest to the width of my previous ones. It seems like the "droop" toward the rear of the saddles will naturally position one's butt in a certain place so I'm not sure about the function of the droop nose. I haven't seen many out on the road, probably due to their high price (about $260 through the standard US mail order retailers). In their catalog, they say that authorized retail shops have half red/half yellow version are avilable for trying out.
I'll let you know if I feel any difference with the droopy nose. Itypically don't move arounf a lot fore-aft so I may not notice it.
d84924 rhys75236
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It's funny that you mention the water. I recently underwent Urethrostomy and after I am drinking 2+ litres of water a day where before I was hardly drinking any. It feels so weird to be drinking so much water and voiding correctly.