Optilume Balloon Treatment for Prostatic Strictures

I wonder if @scurry might have thoughts on this topic.
@rjw4usmc, have you had the Optilume drug-coated balloon (DCB) procedure done?

I had this treatment a week ago yesterday (Aug.29, 2023). My Urologist put a supra pubic catheter in as well, the whole procedure was about a half hour under general anesthesia. No major concerns at this time, just a small amount of blood in the urine at first and not much in the way of pain. I have had dilations and laser surgery previously that did not work, scare tissue from a prostatectomy, then radiation made it even worse. Optilume is much less invasive than urethroplasty, I think it's definitely worth trying.

Davyde,
Wow. Same day as my surgery for the Optilume and Bladder Botox. I am assuming you had this done at Mayo. Why the supra pubic vs. a foley catheter? Like you, my prior laser surgeries have not worked so well. First one lasted 7 months, 2nd one lasted 2 months. Hoping and praying that the balloon treatment with the chemo drug will give us both a longer run without strictures. Are you self catheterizing daily post procedure?

No it wasn't done at Mayo but at the Thunder Bay Regional Health Sciences Center. I have a very bad history of blockages, strictures and stenosis in the urethra. They can form very rapidly, as little as two days after a foley catheter has been removed after either dilation or laser surgery. I did the self catheterization too, it helped for a little while but when I couldn't pass even a 12 mm catheter, they put in a foley. My Urologist wanted to have the supra pubic catheter in as a backup that would be used if I plugged up again, right now it is plugged off and will only be used if needed, it will be in for six months. He also said, he needs to be able to see exactly what's going on in my urethra without having a foley in place. He will be doing a scope later this month and replace the catheter. I finished radiation treatments back in late November, 33 treatments and didn't make it past a full week when I couldn't void at all. A surgeon at our local hospital couldn't get a foley in so they put a supra pubic catheter in, since then, right up to the Optilume treatment, I have had a catheter in. After my first laser surgery I went eleven months without any issues, the second laser surgery this past February only lasted a week before I started having voiding issues again. Really hoping the Optilume balloon works.

Davyde,
Sorry to hear how fast your strictures and blockage are recurring. I can see why the supra pubic is in place and sounds like a reasonable strategy to see how your urethra heals without the risk of retention again. Sounds like your body had an almost immediate bad response to radiation. Hopefully over time that effect will wear off. I do not understand why the first laser treatment lasted so long for you and me but the 2nd one failed really fast for you but even fast for me. Makes you think the laser work can accelerate stricture development. In any case here's to a better result with the Optilume treatment.
Bob

I was back to see the Urologist last Wednesday for a four week checkup and to replace the supra pubic catheter. So far the flow is excellent with incontinence the only issue. He is making arrangements to have the catheter replaced in another four weeks at our local hospital which will save us from making another 454 mile round trip. He will be doing a scope in November to see how things are looking. If I make it through to the beginning of March, he will do another scope and if there is no evidence of scare tissue forming then we will proceed with having a AUS put in. The last dilation I had, was back in December, after the catheter was removed, I didn't even get through 24 hours before I started plugging up and ended up having to have a catheter put back in. In February, I had laser surgery to remove the stricture, a week and a half after the catheter was removed, another stricture and again another catheter had to be put in. The Optilume Balloon procedure is at least promising looking.
Dave

Hi Dave,
Well that sounds like mostly good news. Especially not having to make a 454 mile trip to get your catheter replaced. You and I are exactly the same amount of time post Optilume procedure and from what it sounds like your urethra is clear. That is fantastic. I did not have a supra public catheter but I have been self cathing for the last month - once per day to keep things open. That is working for me but seems to be getting a bit more difficult so I am concerned about stricture reoccurrence. However, this is much better than my last procedure a TUIP, which lasted about a week before I could not get even a 12F catheter in. I am able to still able to use a 14F in which is what I started after surgery so that is encouraging. I am going in for another Cystoscopy this month to see how things are doing. Just got diagnosed on Friday with another UTI which is a ongoing risk with catheterization. Best to you Dave.
Bob

Just had a cystoscopy yesterday, three months after the Optilume procedure. There is absolutely "No" indication of any scare tissue, all tissue is very healthy looking and the area where the strictures were forming remains wide open. We'll do another cystoscopy in three months, if it's as good as yesterdays, then my Urologist will consider the Optilume procedure a success.

Congratulations Davyde. I am 3 months out from my Optilume procedure as well and the area it was done in looks good but I am still have problems at the bladder neck and my incontinence is worse. Got another cystoscopy coming up in 3 weeks. Not sure what the next steps will be. Hoping they can do the Optilume in my bladder neck area as well but I think that is a more challenging spot. Will see but glad you are on the mend. I read the Optilume can last up to 3 years before needing a repeat. That would be nice.
Bob

Hi Bob,
The area where all my strictures form is just below the bladder neck where the urethra was sutured back together. My Urologist told me that incontinence after the Optilume procedure was a good indication that the ureathra is still open. I have had absolutely no bladder control for the last 2 1/2 years so I know what it's like. The supra pubic catheter that was put in during the Optilume procedure is still in, changed out every four weeks and will stay in for at least another three months. My wife changes it here at home now. I connect it to a night bag before going to bed, at least I can sleep and if we are going somewhere, I use a leg bag. The rest of the time I'm either using a clamp or Depends and absorbent pads. Good luck and always hope for the best.
Dave