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

Posted by victor1930 @victor1930, Jun 11, 2019

I have a severe ureteral stricture due to a traumatic catherization. As a result, I have a very thin
stream when I pee and do so very frequently and it takes a long while each time… This leads to
retention of urine when I void causing me to have constant UTI’s. I have had 3 Internal
urethrotomies (VIU’s) with no success. My doctor is recommending having an indwelling
Suprapubic catheter. Do any of you know of any other options that are available to me?
Also, what are the Pro’s and Con’s of having a Suprapubic catheter installed?
Victor

Liked by Leonard

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?

Liked by Leonard, victor1930

REPLY

@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

Liked by victor1930

REPLY

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

Liked by Leonard, victor1930

REPLY
@colleenyoung

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?

Jump to this post

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

Liked by Leonard

REPLY
@victor1930

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

Jump to this post

@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

REPLY
@jakedduck1

@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

Jump to this post

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.:"

Liked by Leonard

REPLY
@predictable

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

Jump to this post

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

Liked by Leonard

REPLY
@victor1930

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.:"

Jump to this post

@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

REPLY
@victor1930

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.:"

Jump to this post

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

Liked by Leonard, victor1930

REPLY
@jakedduck1

@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

Jump to this post

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

Liked by Leonard

REPLY
@victor1930

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

Jump to this post

Your doctor shouldn’t be obsessed about your chronological age. Risk is assessed (or should be) based on health conditions and your medical history. Anesthesiologists evaluate patients based on a 1-5 score and is not affected by your chronological age. It is based on your health. Request that your surgeon refer you to an Anesthesiologist to be evaluated for surgery. Sadly many doctors think if your over 65 your a bad surgical risk. Do you have high blood, diabetes or other health issues that might put you at a higher risk? A lady (95) fell and broke her hip and used a chair to walk to the door to let the ambulance people in. Sadly older people just aren’t given the respect and credit they deserve.
I know a man who was nearly 100 (believe he was 98 at the time) when he fell on an irrigation pipe and pulled himself off the pipe (In his abdomen) and drove home for help. Doctors said his chances we’re slim but they had no choice but to operate, he came through it like a teenager. Later he had a leg problem and they refused to operate based solely on his age. He developed gangrene and the choice was amputation or death. They amputated and he came through like the champ he was. He was fitted with a prosthetic leg and went back to doing every aspect of farming and lived to almost 105. Active up to a few days before he died He never took medication of any kind. They say kids are resilient but so are many elderly folks.
The problem with urethroplasty is there are different procedures with different statistics. Basically they range from a 60-99% success rate. Depending on type of stricture, location, size and procedure. Anastomoses may have the best success rates provided the stricture is small. What reasons did your doctor give for not wanting to operate? I hope there were other reasons besides age.
Good luck on whatever you decide.
Jake

REPLY
@victor1930

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

Jump to this post

Victor (@victor1930), sorry to say I just heard about this bypass directly down from the still-whole section of the upper urethra, so I can't provide any useful information. I can say I'd be interested in learning more about it, and I suspect your urologist has access to the information you're seeking. I'll keep my ear to the ground, and if I run across meaningful information, I'll bring it to your attention here. Having just read about your "uro-surgeon" (?) being indisposed to do the new bypass, I'll express the hope that he's more forthcoming about his reasons. A major one could be that the straight-down surgery (depending on where the upper and healthy section of your urethra is located) may pose nerve and blood vessel avoidance problems, compared with a horizontal straight-out catheter through your body wall. That's the kind of question you deserve to have an answer to. Martin

REPLY

My doctor has recommended having a suprapubic catheter due to constant UTI's caused by severe urine retention.. Is anybody who is using a suprapubic catheter; has used one; or knows someone who has used one; have answers to my concerns:
. Will I have to be "put under": or have localised anasthesia?
My uretheral stricture has a small aperture at the present time. Will i have leakage (due to gravity) from the water tube despite the SP catheter?
Are there any other concerns that I should be aware of ?
Many thanks,
Victor A.

REPLY

Hi @victor1930, you may have noticed I moved your post to the original discussion you started so that all your posts would be in one place. Simply click VIEW AND REPLY in your email notification to get to your post.

I'd like to tag @predictable and @jakedduck1 as they may be interested in your latest development.

What has your research shown so far?

REPLY
@victor1930

My doctor has recommended having a suprapubic catheter due to constant UTI's caused by severe urine retention.. Is anybody who is using a suprapubic catheter; has used one; or knows someone who has used one; have answers to my concerns:
. Will I have to be "put under": or have localised anasthesia?
My uretheral stricture has a small aperture at the present time. Will i have leakage (due to gravity) from the water tube despite the SP catheter?
Are there any other concerns that I should be aware of ?
Many thanks,
Victor A.

Jump to this post

@victor1930
Hi Victor,
Although my first choice would probably be a Urethoplasty, a Superpubic has urethral catheters beat in my opinion. I’d ask your doctor about studies that seem to indicate an increase in bladder cancer. As long as you have regular cystoscopy and catch any cancer in its earliest stage it my not be an issue. Also about the possibility of leakage through the urethra as well as the Superpubic, both of which can occur.
Also I’d ask about the potential of increased bladder stones. Infections are lower with Superpubic vs Urethral. Tell you doctor you want to know ALL the risks as well as the benefits.
I wish you luck,
Jake

REPLY
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