Urethroplasty is apparently in my near future

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Have any of you had this procedure?   I was to have an AMS 800 artificial sphincter implant, but attempts to resolve it by dilation and then a urethrotomy were not successful.   I go in tomorrow for imaging, and then to the doctor's office to get his assessment of what next.  Fortunately, he is a recognized expert at this procedure; otherwise, I would be looking elsewhere.   After nearly a year and a half of incontinence following Greenlight laser in March of 2015, followed by complications and then other procedures,  I am really worn out from living this way 24x7.  I have several friends who've had prostate cancer and prostatectomy, and their successful recovery, compared to my situation, makes me wonder...

I was wondering if any of you have had repairs of strictures that were successful.  

Thanks,

Glenn

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  • Posted

    Hi Glen,

    I have had a urethral stricture since I was born. Just sort of lived with it for many years. Anyway, at 28 and 40 I had a DVIU (Direct visual internal urethrotomy) and a few dilations. I found the DVIU worked great for a year or so, then returned. The second time, the cuts were made a lot deeper, and this time, it lasted for about 2 years, then the flow problem slowly returned. Though that said, I never have any issues really, other than, what I consider, a slow flow, never get up in the night, no incontinence, and have no pains whatsoever. 

    Because I had a very severe UTI, which attacked my prostate, spiking my PSA from average of 2.4 to 15, the doctor wondered if the stricture was the cause of the infection. So, recently, I had a Flow study and a cystoscopy to find the stricture and determine if a Urethroplasty was needed.  Apparently, my flow rate was about average for my age, so Dr not too worried about stricture, but because booked in that afternoon after flow study, he had a look at my urethra/bladder.

    When he saw the stricture, he said it was not too bad and while the Urethroplasty would make me like new again, the very long surgery and recovery was not warranted for the gains. And as I had no "serious" issues, best not to upset the status quo.

    The AMS 800 artificial sphincter implant sounds the bees knees in your situation, as it will once and for all resolve the incontinence.

    ?Geoff

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    • Posted

      Thanks Geoff.   I had a DVIU a few months ago, and it wasn't effective.  So this afternoon, I will have the imaging and then meet with doctor for a decision.   I think the issue with a stricture and the AMS 800 is that if the flow rate is too low, I would have to open the valve more than once.  This would lead to and earlier failure due to wearout.   Also, do do a dilation, the AMS would have to be set in the open condition.  (It has that option.)   I'm 78 and in good health otherwise.  I am just sick of living with wet diapers or the external condom and leg bag 24 x 7.

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    • Posted

      Hi Glen, was thinking about you today and how your imaging/meeting went to determine what next. After one of the DVIU procedures went wrong, I was using the leg bag 24/7 for 5 weeks until an infection cleared up, so they are not fun at all.

      Geoff

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    • Posted

      Thanks Geoff for asking.   Imaging showed a long stricture near the external sphincter.  My local doctor, who does some of that kind of work said he can't do that repair.   I'm in touch with a doctor in CA who specializes in that work, and play to fly out in a couple of weeks to meet with him, have him do imaging and see if he can do the repair.  He doesn't accept medicare, so it would be out of pocket for his surgery, but the hospital where he does the surgery does accept medicare and my secondary BC/BS.

      My local doctor did offer a plan that would involve a dilation, and after a shorter wait check to see if a catheter would pass.  If yes, quicklly do the AUS implant and if not, that would be end of options with him, and leg bags for the rest of my life.  It's been a tough time since March 10, 2016, but I'm working hard to focus on the postives in my life.  It's good to have a loving and caring wife and understanding friends and family.  

      I regret having requested Greenlight laser to deal with my median lobe BPH after reading that it didn't have much bleeding afterwards.   I also regret that my previous urologist didn't say no, since he later said that he considered saying no to me when I requested it (through his nurse).

       

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    • Posted

      Hi Glen

      Sorry to hear of your journey issues. Reinforces our need to research in the forums and on line. As much as the doctors perform a service, we need to be ever vigilant to ensure they do as less harm as possible. The old phrase...more haste less speed....

      Here in Australia, private insurance is a must and many procedures are not be covered by insurance, and if they are, it will be considerably less than the doctors’ fees you encounter.  Mostly, hospital stays are covered by insurance to varying degrees. mpMRI are not covered and mine cost AUD$500, but was well worth it, as it decided my treatment, rather than a blind biopsy.

      Deciding on treatment means deciding what the treatment benefits are over another treatment AND what are the chances of success. While we can research it to the nth degree, our bodies are all different and the skill of the surgeon on the day all matters. You might have some issue that just makes you a good/so-so/bad candidate. Also, as we get older, repairs become more difficult and take longer to heal.

      The less invasive treatment with the best probable outcome is the ideal option.  Maybe the treatment offered by the local doctor is your first option and if he, as you say is a recognised expert in this type of work(SUPER IMPORTANT) can do it, great. If he advises No, then talk to the CA doctor. I presume he carries out a Urethroplasty of the stricture and maybe also the AMS 800? 

      Geoff 

       

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