Urethrotomy , can it be successful?

repetedly told it only had a 50% success rate, but it is worth trying before urethoplasty. Also the Dr performing the procedure is (i am told by the staff in two hospitals) the most respected urologist in the country. It would have been silly for me not to take the op.

The procedure was only 20min. Once I was out from the genral there was only a little pain, but the catheter experience was not nice at all.

I had the Catheter removed the next morning (Painfull but totaly bearable). Straight away I was peeing twice as fast as I have ever done in my life. The dr said it had opened up nicely and it had been a stricture of 1.5cm.

Now just to hope it does not come back. I am going to learn how to self cathetherise next week, then cyto in two months.

Just to hope and pray it works. For now, I an very happy with the op, but it was just two days ago.

Yeah, I think the amount of traffic on here isn't that high, so chances aren't very good of your message being seen at the right moment by someone who would have an opinion.

It's good that they did tell you about the low cure rate with urethrotomy and discussed the possibility of urethroplasty (with its higher cure rate). You've been better informed than a lot of people.

If you do get recurrence - I hope not - then cure with urethrotomy is very unlikely.

[quote:a39620bb93][b:a39620bb93]How to Pass the FRCS(Urol)[/b:a39620bb93]

Q. Describe, in general terms, how you would manage an anterior urethral stricture:

[b:a39620bb93]Avoid the so-called ‘reconstructive ladder’[/b:a39620bb93] where several urethral dilatations are followed by several optical Urethrotomies and eventually definitive surgery in the form of an Urethroplasty. This sequential process may extend the length and depth of the stricture increasing the complexity and compromising the outcome of Urethroplasty.

[b:a39620bb93]Aims of treatment of urethral stricture disease[/b:a39620bb93] – firstly define the [u:a39620bb93]goal of treatment[/u:a39620bb93], which essentially is whether the patient wishes his/her stricture to be [u:a39620bb93]managed[/u:a39620bb93] (periodic dilatations or Urethrotomies) or [u:a39620bb93]cured[/u:a39620bb93] (by Urethroplasty).

http://depts.washington.edu/uroweb/print/pdf/urologyNews_howto_06.pdf

[/quote:a39620bb93]

The stricture is quite bad and blocks 75% of the uretha, though it is not long. It is situated at the base of the penis.

Because of this the Consultant said it would be silly to ignore it, it could lead to problems later on in life.

My condition has little or no impact on my life apart from going to the loo at night

repetedly told it only had a 50% success rate, but it is worth trying before urethoplasty[/quote:bcec75fbc8]

It's a matter of opinion whether or not urethrotomy is worth trying before urethroplasty. Most importantly, it's a matter of [i:bcec75fbc8]your [/i:bcec75fbc8]opinion as a patient. If you feel you can't form an opinion, perhaps your doctor hasn't given you all the information you would need to make an informed decision.

If the stricture is implicated in the infection you had, that might justify surgery. But from what you say, it's unclear whether the stricture has contributed to that. I think it may be a matter of speculation as to whether it did or not.

The popularly-quoted 50% success rate with urethrotomy isn't a blanket figure. That's if you carefully select just the best strictures - short, flimsy, previously untreated, single strictures, located in the bulbar urethra.

I take exception to the suggestion that not doing a urethrotomy constitutes [i:bcec75fbc8]ignoring[/i:bcec75fbc8] the issue. Has your doctor never heard of 'watchful waiting'? It is not \"[i:bcec75fbc8]silly[/i:bcec75fbc8]\".

You say you've always had a weak stream - not that it has been getting worse. You've had an infection - what, once in 26 years? And it was fixed with a course of antibiotics. My feeling is that isn't a bad record. It sounds like the stricture has always been stable and not given much trouble.

\"... little or no impact on my life apart from going to the loo at night\". (That's something I'd never experienced, until after a urethrotomy on my asymptomatic stricture produced a stricture that was far from asymptomatic.)

My view would be that that's quite a problem, and I'd probably have it treated if the treatment gave a good chance of fixing it.

You don't say whether you had complete voiding or had a large residual volume after urination, or whether your doctor reckoned the surgery would help with that, or whether it actually did once you'd had it. It'd be interesting to know.

In my own case, urethroplasty has helped quite a lot with having to get up at night, after the urethrotomy left me with that problem. But I've never regained the bladder capacity I had to begin with.

\"There is always a little dribbling afterwards\". I never had that problem, till the urethrotomy gave me it. I've had to live with it ever since.

You don't mention catheterization in your posting before the surgery, but you do afterwards. Do you mean they didn't tell you about that?

Intermittent self-catheterization is predicated on the urethrotomy not having cured the stricture. It's supposed to slow down recurrence but it's not going to cure the stricture either.

To sum up my own personal opinion:

So there's said to be 75% occlusion. So what? If you're urinating without straining, have a 10 ml/s flow rate, if you're voiding completely (seems doubtful, but it's not really clear from what you say), if it hasn't been getting worse, and if you've only had a urinary infection once in 26 years, then I have to wonder where's the benefit that could justify the surgical risk.

[quote:bcec75fbc8]Urethral Strictures, Male

[size=9:bcec75fbc8]Author: Angelo E Gousse, MD, Professor of Urology and Gynecology, Director of Urology Residency Program, University of Miami, Miller School of Medicine; Director of Voiding Dysfunction, Reconstruction Fellowship[/size:bcec75fbc8]

[b:bcec75fbc8]Surgical treatment of urethral stricture disease is indicated when[/b:bcec75fbc8] the patient has

I am now 70 years old and was diagnosed with Urethral Stricture when I was 25. I don't know how I contracted it. Best guess is that I was hit in the groin when playing cricket!

I had the first Urethrotomy when I was 25 and have had regular urethrotomy (starting with once a month and graduating to once a year).

About ten years ago I had a sudden total cessation of flow which resulted in surgery to cut into my bladder. Following a follow up urethrotomy, I was persuaded to perform self catheterisation. I was reluctant to start with but have avoided any form of urethrotomy for the last 10 years.

Unfortunately, I have had a nother total cessation but am able to make do with the smallest of the single use catheter. Soon I expect to have my first urethrotomy in ten Years.

I hope to able to avoid urethroplasty.

Hope this helps.