Bladder ureteral obstruction/stricture

Posted by jimb1950 @jimb1950, Jul 29, 2020

Anyone else have bladder/urethra constrictor problems? Been dealing with this past 7 mo, now have Supra pubic cath in for past 6 weeks, see specialist next week for game plan. I am completely scarred over. Just wondering what sort of procedures others have had to rectify this problem?

@jackpine

What surgery did you have in Aug? You had a suprapubic catheter and now you don't?

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Urethra constricture surgery, I was scarred & completely shut off, finally put a Supra pubic cath in June kept in post surgery just as a safety valve for couple weeks then I removed it myself at home & have been going ever since. The surgeon I had was absolutely the best.

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@jackpine

Had the BNC surgery on Sept. 18 2020 and have been majorly incontinent ever since. So, am currently using condom catheters, which are irritating the underside of my penis. The other drawback is the requirement to always be wearing a leg bag. Thus, am looking into alternatives, especially the Suprapubic Catheter. Are there any downsides to this procedure? Once it is installed, can it be removed? I gather that the catheter needs to be changed every ~6 weeks. Can it be changed by any doctor, in the event that I'm traveling? Is the suprapubic catheter the best solution? I am 70, had prostatectomy in 2016 and radiation in 2019; the urethra blockage started to occur in Nov. 2019. Thanks for any help.

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@jackpine Welcome to Mayo Clinic Connect. You have surgery in September and have been incontinent ever since. You are wanting to connect with members to get ideas about your options moving forward. Members @kellanns @tom1984 @jakedduck18 have experience discussing this topic and may be able to help with suggestions.

Below I have linked a previous discussion related to suprapubic catheter specifically. You may want to scroll through the posts to see previously offered suggestions and information.

– Stricture of the urethra: Have you had a suprapubic catheter? Other https://connect.mayoclinic.org/discussion/stricture-of-the-urethra-what-treatment-options-have-you-tried/

May I ask when you go back to see your provider for a check in and what options your provider has presented you?

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Erika, many thanks for the information which I have just read. Must research urethroplasties, of which I know nothing. I had a prostatectomy in 2016, after which I was mildly incontinent i.e. using a pad or two or three per day. Cancer was found in one lymph node. PSA rose in 2018. Had radiation March-April 2019. Starting Nov 2019 began having bladder neck blockage due to scar tissue. Had the BNC surgery Sept 2020. Massive leakage (6-7 "pull-ups" per day) ever since. Uro who performed this surgery fixed me up with condom catheters. I am looking for alternatives. I have a remote appointment on January 7 with a new uro. He has mentioned the possibility of an indwelling catheter or superpubic cath. From my experience with catheters (following the two surgeries), seems like the former would be mighty uncomfortable. He advised against artificial sphincter because I am self-catheterizing intermittently. That said, I'm not certain that intermittent catheterizing needs to continue. And one other thing – am on my last injection of hormone therapy, which began in Dec, 2018.

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@alderton

I'm 70 years of age and had a TURP operation 15 months ago to reduce the size of my prostate. In short, the operation didn't work properly. Urinating during the day is normal but night time is a problem – up every 2 hours and then the sphincter muscles refuse to open resulting in my having to massage my penis to stimulate a flow of urine. My urologist has prescribed Valium to relax the sphincter but this isn't working either. No-one seems able to explain why this occurs at night time and why the sphincter muscles don't work as they should. I'm told the next step is a supra pubic catheter which I am trying to avoid. Has anybody out there had a similar experience?

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alderton, Vitamin B1 is involved with the vagus nerve function and a deficiency of B1 (thiamine) may be the cause of your problem. Thiamine requires magnesium to become bioactive but excess carbohydrates or alcohol will turn thiamine off. Research the vagus nerve as it applies to the bladder sphincter muscle and the rest of the body. Then investigate thiamine deficieny and it's impact. Also research benfotiamine a fat soluble form of thiamine that passes through the blood/brain barrier more efficiently yjan water soluble forms.
https://www.objectivenutrients.com/insights/thiamine-ttfd-bladder-emptying-disorders-of-retention-and-incontinence-stones-interstitial-cystitis
https://nootropicsexpert.com/vitamin-b1-thiamine/
https://www.krispin.com/magnes.html

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@jackpine

Erika, many thanks for the information which I have just read. Must research urethroplasties, of which I know nothing. I had a prostatectomy in 2016, after which I was mildly incontinent i.e. using a pad or two or three per day. Cancer was found in one lymph node. PSA rose in 2018. Had radiation March-April 2019. Starting Nov 2019 began having bladder neck blockage due to scar tissue. Had the BNC surgery Sept 2020. Massive leakage (6-7 "pull-ups" per day) ever since. Uro who performed this surgery fixed me up with condom catheters. I am looking for alternatives. I have a remote appointment on January 7 with a new uro. He has mentioned the possibility of an indwelling catheter or superpubic cath. From my experience with catheters (following the two surgeries), seems like the former would be mighty uncomfortable. He advised against artificial sphincter because I am self-catheterizing intermittently. That said, I'm not certain that intermittent catheterizing needs to continue. And one other thing – am on my last injection of hormone therapy, which began in Dec, 2018.

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@jackpine, any new insights from your remote appointment with the new uro today?

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@alderton

Thank you. Do you find the catheter uncomfortable in any way?

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Alderton, I have used the catheter for ten years, as of coming October. I have a plugged urethral valve from Gelsolin which invades, swells, leatherizes, and disables all the valves in the system. I started with ol' red floppies, but have now been on stiff tubes about 8 years. The only discomfort I really have is when I have to work a while, several minutes, to get the cath through the frozen valve. This nearly always raises pain and considerable blood, so my discomfort also comes when I have to clean up the spilled blood around the toilet. This happens every 5-7 days now, and lasts a day or so. I also leak a lot of blood into my shorts.

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@colleenyoung

@jackpine, any new insights from your remote appointment with the new uro today?

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Colleen, thanks for asking. The Uro said that I'm not a good candidate for AUS because my BNC surgery (had a TUR in Sept 2020) suggests that scar tissue will continue to need self-catheterizing, which could tear the device, requiring emergency surgery. I told him I hadn't catheterized in weeks, but he thinks scar tissue will likely obstruct bladder neck down the road, in absence of catheterization. He favors the indwelling catheter solution and has several patients that are happy and active wearing them. I've had to endure them three times in the last four years and don't care for them at all; plus, I came across this quote from Dr. Viers: "…chronic indwelling catheter drainage… is associated with extremely poor quality of life." Plus I believe there are other long-term downsides. The last option is the Supra-Pubic Catheter. What worries me here is the potential for squamous cell bladder cancer. About 10 years ago, I had squamous cell skin cancer removed from my ear. No problem, but does this mean I am prone to this? Can this be nipped in the bud by aggressive bladder cancer screening? // As of now I've made my peace with condom catheters, though not infrequently the adhesive will cause unpleasant chafing that requires me to take a break from them for a couple days, and wear pull-ups, which rather aggravate the situation. It's a Catch-22. I'm waiting for a product to arrive, a "barrier foam", made by the same company that makes the condoms, that may help prevent this. I certainly hope so, because the condom caths seem to me to be the most benign solution. I really appreciate your checking back with me; and sorry for the long answer. I need to get a second opinion from one of the Mayo uros.

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I am a 41 yr old Male.

I am supposed to have surgery this week for a tight bladder neck. I have had the issue for 7 years and my bladder is getting weaker.
I am very scared and not sure if it is the right decision. I have been on flowmax and it helps some. I am on two pills totaling .80.
I am 41 years old and had a qmax score of 6 without any meds and 12 with meds. The meds cause some side effects like eczema and some dizzyness, maybe even some back and side pain.

If anyone has an experience with having a BNI at 5 and 7 could you please share with me your experience>?
My BIGGEST fear is incontinence. I am 41 have two kids and a beautiful wife.

Did you get and form of Incontinence?
Did you get the dreaded Retro?
How long was your recovery time?
Would you share with me your outcome and if any complications?
Did you get the results you were looking for?
Would you do it again knowing what you know now?

Am I jumping the gun having this surgery or am I scared of things that are very unlikely?

I see some people have good flow after the surgery but then find out a few weeks later their slow flow comes back. Thank you for anything you can share.

Thank you,
Joel P

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@joelp

I am a 41 yr old Male.

I am supposed to have surgery this week for a tight bladder neck. I have had the issue for 7 years and my bladder is getting weaker.
I am very scared and not sure if it is the right decision. I have been on flowmax and it helps some. I am on two pills totaling .80.
I am 41 years old and had a qmax score of 6 without any meds and 12 with meds. The meds cause some side effects like eczema and some dizzyness, maybe even some back and side pain.

If anyone has an experience with having a BNI at 5 and 7 could you please share with me your experience>?
My BIGGEST fear is incontinence. I am 41 have two kids and a beautiful wife.

Did you get and form of Incontinence?
Did you get the dreaded Retro?
How long was your recovery time?
Would you share with me your outcome and if any complications?
Did you get the results you were looking for?
Would you do it again knowing what you know now?

Am I jumping the gun having this surgery or am I scared of things that are very unlikely?

I see some people have good flow after the surgery but then find out a few weeks later their slow flow comes back. Thank you for anything you can share.

Thank you,
Joel P

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Hi @joelp and welcome to Mayo Clinic Connect. You'll notice that I moved your message to this existing discussion where @jimb1950 @jakedduck1 @tom1984 @predictable @alderton @victor1930 @jackpine @seamayofan are talking about similar issues with bladder and urether obstruction issues.

Your asking great questions about your upcoming surgery for a tight bladder neck that I think some members will be able to provide tips and have experiences to share.

You mention that incontinence is your biggest fear and that you'd like to know more from those who had bladder neck incision (BNI) about their recovery and if after initial good flow post surgery can regress back to slow flow.

Joel, do the doctors know what the underlying cause of your obstruction is?

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I have been told the reason is a tight and high bladder neck.

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@joelp

I am a 41 yr old Male.

I am supposed to have surgery this week for a tight bladder neck. I have had the issue for 7 years and my bladder is getting weaker.
I am very scared and not sure if it is the right decision. I have been on flowmax and it helps some. I am on two pills totaling .80.
I am 41 years old and had a qmax score of 6 without any meds and 12 with meds. The meds cause some side effects like eczema and some dizzyness, maybe even some back and side pain.

If anyone has an experience with having a BNI at 5 and 7 could you please share with me your experience>?
My BIGGEST fear is incontinence. I am 41 have two kids and a beautiful wife.

Did you get and form of Incontinence?
Did you get the dreaded Retro?
How long was your recovery time?
Would you share with me your outcome and if any complications?
Did you get the results you were looking for?
Would you do it again knowing what you know now?

Am I jumping the gun having this surgery or am I scared of things that are very unlikely?

I see some people have good flow after the surgery but then find out a few weeks later their slow flow comes back. Thank you for anything you can share.

Thank you,
Joel P

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Hi @joelp. Hope I can be helpful, but I want to be sure what we are talking about. I understand that the bladder neck is located near the prostate gland and is the point of exit for urine leaving the bladder and the body through the "urethra" (in contrast to the "ureter," which is one of the two tubes that carry urine from the kidneys into the bladder).

I had surgery in the same area, but not a Bladder Neck Incision (BNI). Mine was a combination of a TURP and a TURB — transurethral resection of the prostate (and the bladder lining). A large piece of the prostate was removed along with several small tumors on the surface of the bladder lining. Within a few weeks, my bladder performance was 20 years younger, and it has remained close to normal. Leading up to that surgery, I too had been on Flomax for several years, but my prostate grew beyond the limits of the drug's ability to be helpful, so we agreed to go ahead with the surgery.

After surgery, I have had regular visual inspections of the inside of my bladder with a cystoscope. In that connection, my urologist also measures my urine flow and samples it for signs of tumor cells. So far, so good, 12 years after my original surgery. Martin

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I had same problem started post prostate surgery removal. Eventually it was completely scarred over had the Supra pubic cath & finally had corrective surgery at Mayo Rochester. Dr Viers was best thing that happened to me in past year.

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