Recurring Bladder Neck Strictures

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Hi, I've had two bladder neck stricture surgeries at two month intervals after open RP and recently a urethral stricture

Uro recommends daily dilation for a year using a Cooksmedical dilation balloon catheter. 

Recently had blood/clots in the urine which cleared after up after 3 hours but now I have a lot more irritation getting the catheter past the urethra stricture. 

Uro says any further Urethrostomy would be serious as he has already cut close to the sphincter ...does this also rule out Urethraplasty?

Has anyone found that daily dilation works long term or does the stricture eventually close in. 

I noticed that after waiting 3 days for a new catheter to arrive it was then very difficult to insert it. ...as opposed to daily dilation.

Is there an alternative catheter as this one costs €220

James

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  • Posted

    Hi, James,

    Please forgive my chipping in on your thread. Glad the SpeediCath worked out, but I was going to get back to you on the catheter sizes you mention.

    Now, to pass on to someone else the advice given by a Uro to his patient, is a bit like sharing drugs. In short, don’t do it!. However, on this unusual web site the audience seems to be mature enough to be thoroughly analytical and informed.

    I started weekly cathing a year ago with the sole intent of keeping retained urine down to an acceptable level. I had started with a 18Fr SpeediCath which glided easily through most of the urethra. Slowed a little upon encountering the outer sphincter but came to a halt (should I say a “screeching halt”?) a little before reaching the inner sphincter. The SpeediCath was replaced with a 16Fr straight Red Rubber (all I had in that size at the time). This arrangement continued to the present day and has been entirely successful.

    On several occasions I suggested to my Uro that perhaps I could move back up to the 18Fr size, which he refused to do. Here is his reasoning:

    The 16Fr that I am currently using is not irritating the urethra and is performing its task of keeping the stricture open at an acceptable level. Increasing the catheter size to 18Fr, though physically compatible with the urethra along its entire length, could cause some irritation in the narrower sections, and quite likely irritate the stricture proper. "Let sleeping strictures lie”?  (Now that’s corny!) In short, we have a fine balance here; let’s maintain it for as long as possible.

    The man has made a good point, but would it be applicable to you, James? So, I would tend to concur with Colin’s logic and suggest that a 16Fr might be quite adequate; it certainly has been for me.

    Good luck!

    Alan.

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    • Posted

      Hi Alan,

      Thank you for your comments.

      I should say I understand the logic behind my Uro's decision in recommending a ballon dilation catheter ie to keep the bladder neck stricture as open as possible. The 27Fr is doing that but it's been a very uncomfortable experience and I agree with your Uro about causing irritation. I could not believe the difference in the Speedicath.

      I guess that's the reason why the balloon type is not popular.

      I would much prefer only using the 16Fr but I will need to find out will it increase the risk of recurrence ..but who knows!

      Well done on your own success with keeping the stricture at bay.

      James

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    • Posted

      Hi, James,

       

      Further to my previous post to you, I sincerely apologize for failing to recognize your problem concerned strictures in the urinary bladder neck. I therefore presume that your 27Fr dilation catheter is fully justified.

      I commiserate with you! Warm regards and best luck for the future,

      Alan

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    • Posted

      I realised the new Speedicath 16Fr was not getting past the stricture so I changed to the 14Fr which has the coude tip (narrow tip) but it stops at the stricture aswell. I dilated the bladder neck stricture with the original balloon dilation catheter 27Fr and then tried the Speedicath 14Fr again and it still stops dead at the stricture. I did not want to push too hard. It seems the very narrow tip on the balloon catheter is the only reason that it gets past the stricture.

      Just wondering does any other dilation catheter have this very narrow coude tip.

      James

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    • Posted

      I've never come across a coude tip until you mentioned it, James. It's always a bit of a push to get my SpeediCaths past the sphincter, but I just go very very slowly, a millemetre at a time sometimes, to avoid irritation. Have you tried just being firm but slow?

      Sometimes, especially when I have a urinary infection, it feels like I'm just hitting a wall and no amount of slowness or firmness will work - I can feel the catheter start to bend in the urethra rather than go through. In that case I just give up, withdraw the catheter and wait a minute or two. Usually that's enough to relax the sphincter enough for the catheter to find its way in.

      I don't know if this will help you. As I say, I've no experience of coude tips. But I hope you find a way that works - obviously you do need to get past the shincter in order to dilate your bladder neck stricture.

      Best wishes,

      Colin

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    • Posted

      Hi Colin,

      I will try it again but its like a brick wall. With the other catheter it's different ...the narrow tip just pushes true.

      I am dilating the strictures with the balloon catheter but it's irritating.

      I will have to search for an alternative.

      Regards

      James

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    • Posted

      Hi, James,

      First, I’d like to comment on your statement “coude tip” (narrow tip)”. This suggests that your interpretation of the term ‘coude’ is that it is narrow. To the best of my knowledge the term derives from the French for “elbow” and indicates that the catheter tip is actually bent to one side of the catheter. My understanding is that this is to facilitate negotiation of difficult obstructions that might be encountered along the urethra.

      You should find two distinguishing features which identify your 14Fr catheter: the final length of the tip (about ½ inch?) is bent at about 40 degrees from the axis (center line) of the catheter proper and, at the opposite end of the catheter there a mark or indicator of some sort that aligns exactly with the plane in which the tip is bent. This mark could be a raised strip of the molded plastic, or an indent in the catheter material, or even just a printed line.

      This indicator is vitally important because it tells you exactly in which direction your catheter tip is pointing even when it is completely out of sight.

      I hope you find this helpful. Good luck, and keep in touch!

      Alan

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    • Posted

      Hi Alan, 

      I was just giving a brief description, it is an elbow.

      The issue is the balloon type has a very narrow elbow compared to the Speedicath elbow and it's this feature that makes the difference between which catheter gets true the stricture and which one does not. 

      Hopefully there is another make out there with this feature but without the balloon.

      James

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    • Posted

      Hi, James,

      Can you give me an idea, in terms of diameter and taper, of the ideal device you are looking for? I am in the process researching catheters selected by their length so I could keep an eye out on your behalf, if that is o.k. by you. I would watch for catheters and sounds and, if successful, send you the source via Private post.

      There are many special purpose catheters out there for different applications, but precious few sterile ones suitable for insertion in the human body and which are longer than the standard length of 12 1/2 inches.

      It was only when I began to self-cath myself last year that I discovererd that my urethra was some 2 inches longer than what might be regarded as normal!

      All the best, Alan.

       

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    • Posted

      Hi Alan,

      The balloon dilation catheter is 8.7mm, 26Fr dilated

      Coude tip tapers from 4mm to 2mm and is 30mm long.

      If the speedicat 16CH or similar had the above coude tip, then that should keep the stricture open.

      Thanks for that.

      James

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