I will give my personal experiences as well as give some...

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I will give my personal experiences as well as give some tips for post operative urethraplasty.

I am a male, 28 years of age. I have had a slow stream since I was a child. I never thought much of it, as I did not have problems. However, mid 2005 (at the age of 28 ) I started to have some urination pain and occasional blood in my urine. Soon after, I had a total blockage; I could not urinate some time after I ejaculated. I rushed to the hospital where they attempted to insert a catheter (but they could not get it in). Fortunately, the force of trying to insert the catheter stretched me enough that I could urinate.

I was fine for another month, after which I ended up at the ER again, which was seemingly prompted by ejactulation once again, but was able to pass urine right before they tried to insert the catheter. Note: Catheter insertion can be the most painful thing imaginable if you have a bad stricture and it is 'forced' into you. I went to a urologist where they performed an endoscope analysis. They could not insert the probe through the stricture. I was referred to another doctor to have a retrograde urethrogram performed. The first attempt at this was a failure, as they could not insert the catheter into me while I was awake, due to the extreme pain it caused me. I had the procedure done again, but this time I was under anesthetic. A 2.5cm severe stricture was found to present in the curved section of the urethra, right before it goes up to the bladder.

They scheduled a urethraplasty graft, which involves removing donor skin from one part of the body, slicing open the urethra along the stricture and reconstructing it to free up the path. In early October I underwent the surgery. Here are some things that you should expect, that my doctors did not explain:

(1)Your scrotum will probably be increased in size by several times due to swelling. It will hurt considerably.

(2) Your catheter will be(in the case of where my stricture was located)taped in a position on your adomen. It will pull your penis up towards you adbomen. This is to prevent the catheter from applying force on the healing incision. This is very painful way to have a catheter installed when you experience non-voluntary erections. The erection will try to stand your penis up, but the taped catheter to your adbomen prevents this. The force on the tip/opening of your penis may be severe. It was for me. Walking was very difficult.

I recommend using a sterile lubricant such KY jelly, applying it around the opening of the penis and catheter where it enters. This helps reduce the dry friction on this spot.

I recommend purchasing two types of medical tapes in high quanities. 3M Durapore to hold the catheter in place most of the time (it's a very comfortable breathable tape, and it is very strong adhesive).

I suggest a very heavy duty waterproof tape for when you take showers, but I can not recollect the specific brand right now. The Duropore is not waterproof, and the high quality waterproof tape is not comfortable. I tried many different tapes and Durapore was the best I found for standard use. In fact, many tapes did not even hold for more than a couple of minutes, thus were useless.

I recommend getting at least 2 high quality leg bags and 2 bed-side bags, along with extension tubing. You must sterilize the bag and tubing with white vinegar daily to reduce the chance of infection. I would first sterilize with vinegar, then wash out the tubing and bags with Dawn dishwasing detergent. Rinse very thoroughly. You need to set up something to securely attach the bag to the side of the bed below your abdomen level(so that it drains). You will want to use a leg bag attached to your lower leg, using an extension tube, for the most practical comfort during the day. Besides, it is a bad idea have backflow from a bag attached to your thigh when you sit down.

I had to suffer a catheter for 3 weeks (originally scheduled for 4) and it was the most miserable time in my life. I have had open surgery before on two occasions, but it was nothing like this. For me, the catheter caused severe irratation/pain (best described as a burning in my urethra) whenever I tried to move for more than 5 or 10 minutes. I had to remain bedridden for most of the day for those 3 weeks. Combine this with the dry friction/pain of the catheter in the way that it is taped to the abdomen for an unforgettable experience.

To prevent erections, some people may be able to take ketoconazole (Use of oral ketoconazole to prevent postoperative erections following penile surgery - K C Evans, A C Peterson, H E Ruiz and R A Costabile, International Journal of Impotence Research, August 2004, Volume 16, Number 4, Pages 346-349). The ketoconazole relieved the erection pain problems, but I had strong negative side effects to the medication. I had violete tremors, my muscles had extreme aching and I was so nauseous that it must be experienced to have an accurate reference. It must be noted that my reactions were not typical. The medication will work effectively for the most people with only mild side effects.

The catheter was not forgetable for me, it was always present and always a source of pain/irratation. I should add that if you can use the keto med, do so for the entire time while the catheter is installed.

My erections became worse after about 10 days post op. I am used to regular ejaculation (once every 2 days) and the built up frustration after 10 days was intolerable. I had erections that would last for hours at a time and would only come back. I resorted to ejaculating with the catheter installed (yes, this is not a good idea, but I did consult with 2 urologists, both of which did not think it was likely to cause a big problem, but no guarantees) to relieve myself.

Another source of pain (at least for the first week) was that the skin graft was taken from my penis shaft. I was already circumsized, but they took skin from me anyways. This was in violation of pre-op discussions, which they examined my inner mouth tissue and agreed to remove the skin from my inner mouth cheek. I woke up with a horrible suprise in recovery room. They had cut all the way around my penis and removed skin, sewing it back together. This was rather painful. It left me very numb after the pain stopped. If I had been able to take keto, it would not have been an issue. Keto is like an off switch for your testorone production.

I had my catheter removed in early November. I can now urinate at approx. 30 ml/second rate, which is excellent. Pre-op, I averaged 6 ml/second. The xrays from November show no evidence of a stricture ever existing. Excellent work was done, apparently. I must go back in Feb. 2006 for a follow up.

I realize that my descriptions sound horrible (they were!), but the relief of being able to urinate and not have urinary pain were well worth it in the end. The removal of skin from me pre-circumsized penis was horrible. I can no longer enjoy sex the same, and I am still numb 2 months afterwards. In addition, the skin on the back of my penis is not very tight when I am erect, so that it caused some pain/discomfort. I can only hope this eventually goes way.

My experiences may be exceptional, and most people should not have the magnitude of problems that I experienced. I hope that I was of some assistance.

C. Wolff

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  • Posted

    I am guilty of not properly proof-reading my comment before submitting. The statement: "In addition, the skin on the back of my penis is not very tight when I am erect, so that it caused some pain/discomfort. I can only hope this eventually goes way."

    This should state".....the skin on the back of my penis is very tight when I am erect....."

    [i:a6f22d8cfd]This message was automatically imported from the original Patient Experience[/i:a6f22d8cfd]

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  • Posted

    I have a follow on question. My procedure was exactly like yours with the exception of the skin graft; mine came from my mouth. Like you, the cathether was the worst part of the experience. The surgery was done in July and last week I had a retrograde urethragram done and everything looks okay. My question is in regard to sexual function. Pre-op, ejaculate was less than normal which I attributed to the stricture. Post-op, erections are no problem and ejaculation is no problem except for the fact that it is a dry ejaculation. What was less than normal is now non-existent.

    I guess it's not a major concern since the normal sensations are present, sex is still pleasurable, and as I am 50, I have no desire to father any more children than the two I have. Nonetheless, I wonder if you had a similar experience?

    [i:92558b87d9]This message was automatically imported from the original Patient Experience[/i:92558b87d9]

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  • Posted

    Kevin: I can only offer my subjective perception of ejaculate amount. It seems to me that my ejaculate output is improved after the operation. However, my ejaculate amount does not seem as high as I remember it being, say, 2 years prior to the operation. At least ejaculation no longer hurts; it was painful for the last few months right before the operation.

    C. Wolff

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  • Posted

    hi there very interesting to hear your account of urethroplasty. i am due for the same surgery in the coming months and im very apprehensive. Been living with a suprapubic catheter for 2 months now because the stricture is so severe. i had exactly the same problems in that after ejaculation urinating was almost impossible. I have had two optical urethrotomys and after those urinating was heaven and very powerful i am just wondering if the plasty operatipon will enable me to pass as effectively would be grateful if you could reply to me **** thanks

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  • Posted

    l.pyatt: 7 months after the surgery, and my flow rate is still superb. Still hitting peaks up to 30mL/second, with no sign of re-occurring stricture. However, my surgeon, while being arrogant, is one of the leading/most experienced urologists in the United States. Skill/experience of the surgeon is of prime important determining the chances of a successful procedure. Of course, there is still the chance that no matter how good the surgeon, that the procedure will not work, due to various uncontrollable factors. I feel so much better than I did pre-surgery. Every time I urinate I am thankful for the relief now. I may have left some details out of the article I wrote, because it was not proof-read. I just felt like typing it out one day. If there was an edit function I would revise some of it to include more information. Please feel free to email me at **** and put 'Urethral Stricture' in the subject line so that it does not get trashed. I'll answer any question you want, and try to help you prepare.

    C. Wolff

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    • Posted

      Hi C. Wolff,

      It will not show your email address so I cannot email you, but I would like to ask you about your post-op voiding. I had the surgery done as well approximately a month and a half ago and I have started to feel some pain when I urinate or ejaculate -- it reminds me of the pinching pain I would feel before the surgery. I was wondering if you feel anything when you pee now? I am afraid there is something still there blocking my urethra, although the stream seems to be fine.

      Thanks,

      Peter

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