Stricture of the urethra: Have you had a suprapubic catheter? Other?

Hi @victor1930 and welcome to Connect. I'm bringing @palevsky, who has experience with a suprapubic catheter, into this conversation. I'd also like to invite @predictable @harleymama and @rans who may be able to offer experiences on urine retention and frequent UTIs.

Victor, what led to the original catherization that resulted in these urinary tract issues?

@victor1930
Hi there,
Have you tried the external condom type catheters? This type reduces irritation to the bladder lowering the risk of infection, also an irritant and thereby bladder cancer. Of course it’s important why you need a catheter. My Dad was paralyzed and used both external and foleys and was thinking about a superpubic but never had it. If you choose a superpubic there may be an increased risk of bladder cancer. Caution also must be taken not to insert the catheter to deeply. You want to avoid damage and irritation to the bladder and accidentally going into the urethra. Infection is a concern and some say sterile gloves aren’t necessary but I always used them. Infection does seem to be less with the superpubic but that depends how careful the person is who puts it in.

Some pros,
Usually more comfortable than urethra type.
Easier to have sexual relations.
Usually lower risk of infection.
Accidents or damage not as common.
Procedure is reversible if you go to a different type.
Larger catheters can be used.
You’ve got options.
Use bag or drain directly into toilet.

Cons,
Sensitivity, might become hypersensitive in some people but in some it may go away. The site may be uncomfortable.
Not a good option if overweight.
Possible discharge at site.
Risk for infection.
Higher risk of bladder stones.
The site may begin to heal/close.
Possible blockages.

I wish you luck whatever you decide. Health and happiness,
Jake

Hi @victor1930. Glad you joined us on Mayo Connect and hope we can be helpful by sharing our own experiences with bladder and urethra urinary problems. My urethra gets periodic checking during cystoscope examinations of former cancer sites on the lining of my bladder. I also had transurethral resection of prostate (TURP) procedure that removed prostate tissue through my urethra. That was about 10 years ago, and I have had no serious UTI problems since.

However, my late father had problems that seem identical to yours. When his urethra became useless as a urine pathway, his urologist persuaded him to accept a suprapubic catheter installed to carry his urine through his body wall and into an external bag. While that worked well for a number of years, from time to time he would suffer from infection/inflammation in and around the catheter's path through his body wall. As he passed his 90th birthday, these instances occurred more often and were more serious, perhaps mainly because of his advanced age, declining ability to care for himself, and failure of the medical staff of his final residence hall to help him deal with the problem. He was nearly 95 when he breathed his last -- not from infection, so far as we know.

Hopefully my dad's experience will suggest what information you may wish to have before making a decision on a suprapubic catheter. And I hope you have full confidence in the advice and treatment that your urologist offers you. If you have any doubts, you may wish to ask for a second opinion from a disinterested urologist. Martin

Hi Colleen,
Thanks for your response. Here is a gist of how I ended up with this stricture.
In 2008, I was diagnosed with prostrate cancer (Gleason 7) and opted for radiation treatment because it was a non-invasive. When my PSA began to rise after 2 years; I had hormone (Telestar) injections every 3 months. Everything went well for the next 7 years. On March 7, 2017 I found myself passing clots of blood while urinating. I called my uro-oncologic surgeon’s office and was told to go to the Hospital ER as the Doctor was not available. At the ER. A nurse was assigned to catherrize me; a procedure I had never experienced. I knew that she would put a catheter into my penis to reach the bladder to drain the clots out. She proceeded but instead of expecting discomfort, I was getting a lot of pain while she tried to push the catheter. She kept on shoving and even called a colleague and both kept on shoving even using their hip to shove. The pain was unbearable and I even passed a stool with the pain. I then asked them to stop and take me to the Urology Dept. The doctors there put me under and when I came to, I was in a hospital bed. The next day the surgeon came to see me. My scrotum was the size of a baseball and I had a catheter. He explained that the nurse had found a false passage while catheterization that caused the problem. Three weeks later my Surgeon (Dr. N. F) told me that as a result of this “traumatic catherization” I had developed a large stricture which allows only a thin flow of urine. Now after 2 years and 3 urethrotomies (VIU’s) there is no improvement and UTI’s are frequent. Hence his suggestion of a suprapubic catheter.

Victor

@victor1930
Hi Victor,
My cousin had problems and the doctor did a dilation procedure. It was unsuccessful. Have you considered removing the stricture by way of a urethroplasty? This is probably the most successful treatment for this issue and personally I’d seriously talk it over prior to your catheterization. If successful it would prevent numerous potential problems in the future. Also I’d get some other opinions.
According to US News and World Report here are there recommendations of the best hospitals for Urology care.
https://health.usnews.com/best-hospitals/rankings/urology
Good luck whatever you decide.
Jake

Hi Jake,
Have you know of this possible option ( in lieu of a suprapubic catheter) :

"Option is not to reconstruct the urethra at all, and instead make a bypass for the urine instead. Here, the urethra is opened under the scrotum, and a paddle of skin sewn to the urethra. Thus, with the bulbar urethra sewn to the skin, the urine can easily come out. However, the patient will need to sit to urinate. This is a reasonable solution for the severely scarred urethra in a more elderly patient.:"

Hi Martin'
Do you know of this possible option ( in lieu of a suprapubic catheter) :

"Option is not to reconstruct the urethra at all, and instead make a bypass for the urine instead. Here, the urethra is opened under the scrotum, and a paddle of skin sewn to the urethra. Thus, with the bulbar urethra sewn to the skin, the urine can easily come out. However, the patient will need to sit to urinate. This is a reasonable solution for the severely scarred urethra in a more elderly patient.:"
Victor

@victor1930
Yes, there are various type of urethroplasties the one you suggest being one of them. I’m curious why the doctor didn’t recommend one of these procedures. Possibly because Catheterization is the simplest and least invasive. However catheters do carry serious risks. My Dad developed bladder cancer from chronic catheter use along with infections. I’d be curious about the statistical data regarding bladder irritation and cancer.
There are risks regardless of the choice you ultimately decide on.
Good luck,
Jake

Further to my last post; does anybody know how successful this bypass option is; or know of anybody who has previously done it ?. I would like to have it done in my situation but wish to have information on the length and/or how complicated the procedure might be' as I am in my 80"s. Would be very grateful for help or advice. Thanks

My uro- surgeon,does not consider me a candidate for urethroplasty because of the length of the operation and the fact that i am in my 80's and it would be too risky