Mel, not sure where to start. The 6 months mark of this SP was not meant to be a celebration, more a statement of fact.
Yes, a person can be scoped and dialated, without a need for another catheter, if the blockage is small and easy to fix. I have never been fortunate enough to have any of mine that easy.
Some strictures are in the urethra itself, can be close to the penis tip (not as common), halfway up, or just outside the bladder neck (probably the most common). You can also have them right in the bladder neck itself (this is where 100% of mine are). These kind are harder to deal with, and can cause more chronic scarring situations like I have.
You can also, post surgery, have a "flap", a small piece of tissue that usually pushes out of the way when you pee, but sometimes will get in the way and cause a blockage. These can usually be fixed with a scope and a blade inside the scope, and the uro will find the flap, and cut it away. If it is tiny, probably wouldn't need a cath, but if larger and if he has to cut more, then not uncommon to need a foley cath for a few days to a week, to allow healing.
With most strictures, they are often cured with one or two attempts at fixing. Usually the first attempt is done with a scope, and if that fails, a small corrective surgery like Subic just had will do the trick. While I wish Subic the best that his has been fixed, its too soon to know for sure, sometimes, it can take 6-12 months for scarring to do it work creating still another stricture. I hope that doesn't happen to him.
My shortest blockage episode took place in less than 8 hours after a cath was removed. My longest period before I had total blockage was about 4 months. As the weeks went by, my already small flow just slowly deceased, and it took more and more effort to pee.
Since July of last year, nothing seems to keep me from having my bladder neck scar over. My uro/surgeon said he had never seen anyone scar over that fast. At one point, I had a corrective laser surgery, and within 6 weeks or less, was 100% blocked. This is why I have been on a continuous SP catheter since October 1st.
When I went through radiation, it is not uncommon for the urethra to decrease in size and cause serious flow problems. Knowing my history, all sides decided that this would be the best route to take.
The trouble with ER workers, you never know what you are going to get. My local ER is but two blocks away, a small hospital, perhaps 90 beds. After we have our open or robotic surgeries, we have had our plumbing re-routed, and in many cases, there are sensitive and touchy connections. So it would be easy for a clumsy ER worker to injure you trying to put in a catheter. They typically dont do many, and probably few have dealt with post-surgery PC patients like us. My one time ER experience was a scene from the worse part of hell, one I would never intend to repeat.
Coming back to you, Mel, with all you described, I would almost suggest having your uro scope you, so that he/she can see what the urethra looks like and how the opening is looking at the bladder neck. That way, if there is a problem developing, they can deal with it before it become an emergency situation. If it is just a tight urethra situation, they can do a "soft" dialation through the scope. It will stretch your urethra back open a few sizes to make it easier to pee.
You would want at least a local sedative, demoral is what is used with my dr (100mg) 30 minutes before being scoped. If you aren't in an emergency situation and if you not having pains from an UTI, scoping doesn't hurt real bad. Dialation can hurt terribly, depending on what is going on. Unfortunately, all of my dialation attempts while not being put under, were terrible traumatic events due to complications, so I am not the best example of having them done.
If your urethra and bladder neck look fine, then your described issues might have another cause, not sure what to tell you. The more you strain, the more you wear down that bladder neck, so the pain and effort usually increases as the day goes on. In the same manner if a man goes nuts doing keagals too much. It can be counter productive.
I hope you get a solution, yours does sound like an aggervating thing to deal with too. If you have a true blockage, you will start getting a deep back pain, your bladder will hurt all inside you, and any attempt to get even a drop of urinie out will be excruciating. Sitting always made my blockages feel worse, so I would get up and pace back and forth. But there's no greater feeling of pain relief, even if they have a difficult time inserting the catheter, when that cath pokes into the bladder and immediate starts gushing out the blocked up urine, at that point, your level "10" pain will decrease within seconds.
As a final note, I hate catheters, all men here hate them. Most are lucky for it to be a one time shot of 5-14 days. But when you suffer from blockages and strictures, you would beg to have one put in, probably next to having a spinal tap go terribly wrong (about 12 years ago), a total urinary blockage one of the most painful t hings I have experienced. So dont wait too long if you even think its happening to you.
David in SC
Good luck, Subic, hope the flow stays with you.
Age: 57, 56 dx, PSA: 7/07 5.8, 7/08 12.3, 9/08 14.5, 10/08 16.3
3rd Biopsy: 9/08 - 7/7 Positive, 40-90% Cancer, Gleason 4+3
Open RP: 11/08, Rht nerves saved, 4 days in hospt, on catheters for 63 days, 5th one out 1/09
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos margin
Incontinence: 1 Month ED: Non issue at any point post surgery, no problem post SRT
Post Surgery PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12
Latest: 7/9 met 2 rad. oncl, 7/9 cath #6 - blockage, 8/9 2nd corr surgery, 8/9 cath #7 out 38 days, 9/9 - met 3rd rad. oncl., mapped 9/9, 10/1 - 3rd corr. surgery - SP cath/hard dialation, 10/5 - 11/27 IMRT SRT 39 sess/72 gys ,cath #8 33 days, Cath #9 35 days, 12/7 - Cath #10 43 days, 1/19 - Corr Surgery #4, Caths #11 and #12 same time, 2/8-Cath #11 out - 21 days, 3/2- Cath #12 out - 41 days, 3/2- Corr Surgery #5, 3/6 Cath #13 out - 4 days, Cath #14 out - 27 days, Cath #15 - 3/29