bladder neck contracture post op

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yobiks
Regular Member


Date Joined Feb 2011
Total Posts : 39
   Posted 4/16/2011 8:51 AM (GMT -6)   
just got off the phone with pigeonflyer after describing what and where I am at. Looking back thru the posts you will see I have had a urinary retention problem. Hopefully we got to the bottom of it 2 nights ago. Went in to my doctor's office to get cystoscopy and see what was going on. We found a flake of salt (stone) wedged sideways in the bladder neck. The bladder neck also was contracted and we saw something shiny (turned out to be a stitch) peaking out of the bladder neck. Tried to reinsert the catheter at that point (I had removed it 5-6 hours earlier) with no luck. Started with a 16f and went down thru the size chart to a 10f before we achieved success. Yes I was a sweaty puddle of tension by then. My doctor decided to do the surgery that night. Long story short the bladder neck was lasered to a 19f big enough to get the scope into the bladder and the debris was eliminated along with the loose stitch. This whole ordeal is more than I had hoped for. I am getting the catheter out in 1 week and then I will be self cathetering myself once a day for 6 weeks to keep the scar tissue from returning. Comments?
age 56
sept 28 2010
psa 2.1 ,t2b
jan10 '11 gleason 3+3 t2b
open rp scheduled march 1 2011
Both nerve bundles spared
post surgery path: t2c gleason 6
neg margins neg lymph nodes
organ contained adenocarcinoma

davidg
Veteran Member


Date Joined Feb 2011
Total Posts : 4093
   Posted 4/16/2011 8:55 AM (GMT -6)   
God bless you is my comment.

Does this happen often to people?

My boss had to learn how to catheterize himself also. He had done HT followed by seeds. He said that the process of putting in the catheter and removing it alone wasn't a big deal.

yobiks
Regular Member


Date Joined Feb 2011
Total Posts : 39
   Posted 4/16/2011 9:09 AM (GMT -6)   
looks like I hit the trifecta on causal agents for complications. Good news is they took care of it with 1 turn on the operating table. The catheter is going to be to keep scar tissue from reforming. I have been on a catheter since March 1 with 2 attemps to remove it. Both times I had urine retention issues.
age 56
sept 28 2010
psa 2.1 ,t2b
jan10 '11 gleason 3+3 t2b
open rp scheduled march 1 2011
Both nerve bundles spared
post surgery path: t2c gleason 6
neg margins neg lymph nodes
organ contained adenocarcinoma

yobiks
Regular Member


Date Joined Feb 2011
Total Posts : 39
   Posted 4/16/2011 9:11 AM (GMT -6)   
I guess the thing that has been bothering me is reinserting that catheter again. What I am getting so far is that it is not as bad as it looks.
age 56
sept 28 2010
psa 2.1 ,t2b
jan10 '11 gleason 3+3 t2b
open rp scheduled march 1 2011
Both nerve bundles spared
post surgery path: t2c gleason 6
neg margins neg lymph nodes
organ contained adenocarcinoma

davidg
Veteran Member


Date Joined Feb 2011
Total Posts : 4093
   Posted 4/16/2011 9:12 AM (GMT -6)   
retention was my biggest post op concern. I'm sorry you are having to deal with this.

Did they notice retention right away after taking catheter out post op or did you go home and have to go through agonizing ordeal by yourself and then go to ER to have catheter placed in again?

davidg
Veteran Member


Date Joined Feb 2011
Total Posts : 4093
   Posted 4/16/2011 9:13 AM (GMT -6)   
it's an ugly thought, but like I said, my boss joked about. Said it wasn't a big deal.

yobiks
Regular Member


Date Joined Feb 2011
Total Posts : 39
   Posted 4/16/2011 9:20 AM (GMT -6)   
2 trips to the er to get new catheters. the second trip was compounded by normal er hijinx. just about going into shock before they got it in the second time. hopefully that is behind me now.
age 56
sept 28 2010
psa 2.1 ,t2b
jan10 '11 gleason 3+3 t2b
open rp scheduled march 1 2011
Both nerve bundles spared
post surgery path: t2c gleason 6
neg margins neg lymph nodes
organ contained adenocarcinoma

clocknut
Veteran Member


Date Joined Sep 2010
Total Posts : 2667
   Posted 4/16/2011 9:21 AM (GMT -6)   
Yobiks, I'm very sorry to hear you've been having these problems. I hope this latest procedure settles it once and for all.  I broke into a sweat just reading about your latest experiences. 

Post Edited (clocknut) : 4/16/2011 9:27:14 AM (GMT-6)


yobiks
Regular Member


Date Joined Feb 2011
Total Posts : 39
   Posted 4/16/2011 9:24 AM (GMT -6)   
2 trips to the er to get new catheters. the second trip was compounded by normal er hijinx. just about going into shock before they got it in the second time. hopefully that is behind me now.
age 56
sept 28 2010
psa 2.1 ,t2b
jan10 '11 gleason 3+3 t2b
open rp scheduled march 1 2011
Both nerve bundles spared
post surgery path: t2c gleason 6
neg margins neg lymph nodes
organ contained adenocarcinoma

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 4/16/2011 12:02 PM (GMT -6)   
yobiks,

if you know my journey, it was one of extreme stricture issues that were never totally solved. i was on a total of 21 catheters, i spent about 1 1/2 years on them, including my last stint of 51 continuous weeks with a suprapubic catheter in place. I had two emergency dialation procedures in the uro's office, 2 ER visits, and 6 corrective day surgeries. in the end, once my bladder was bypassed for life and a stoma created, i will never have to worry about strictures or caths again. it was a terrible process.

my uro said some men can handle the self-cath routine, and some can't. I was one of the cant group. I had too much damage al lthe time at the bladder neck, and he was afraid i would injure myself self-cathing, and I am not circumsiced, which can make it a little more diffiuclt.

unlike my story, i hope yours has a happy ending.

david in sc
Age: 58, 56 dx, PSA: 7/07 5.8, 10/08 16.3
3rd Biopsy: 9/08 7 of 7 Positive, 40-90%, Gleason 4+3
open RP: 11/08, on catheters for 101 days
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos margin
Incont & ED: None
Post Surgery PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12, 4/8 .04, 8/6 .06, 2/11 1.24, 4/11 3.81
Latest: 6 Corr Surgeries to Bladder Neck, SP Catheter since 10/1/9, SRT 39 Sess/72 gy ended 11/09, 21 Catheters, Ileal Conduit Surgery 9/10

Northfoot
Regular Member


Date Joined Mar 2011
Total Posts : 81
   Posted 4/16/2011 4:17 PM (GMT -6)   
Yobiks,
I agree with Purgatory. Assuming there is not extensive damage to the bladder neck. It should be physically easy to self-cath. My schedule for doing it after cystoscopy and dilatation was also daily for six weeks. Emotionally, it was very hard to do. I guess the best thought I had when doing it was that it was an amazing length of catheter that I fed in --- a source of pride, if you get the joke.

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 4/16/2011 4:48 PM (GMT -6)   
When a woman is catherized, its a short trip, but much more difficult to insert. With men, regardless of penis length, it's a much longer path, though with curves involved, and the entrance point is easier to access in most cases.

My uro is not big on self-cath for post Prostate Surgery guys, for the reason stated above, the juncture of the urethra and bladder neck has changed greatly from your pre-surgery state. My doctor believes, that after a dialation, keeping a cath in place for weeks, or longer in my case, allowed better healing and prevented closure in general, and to avoid me hurting myself in the process, making things worse. My case was extreme, I admit, and doctors choose to do things their own way of course.

Two times as the result of severe strictures, I had to have two caths in me at the same time. Sounds amazing, but true. I had the suprapubic catheter coming out of my skin to the left of my navel, to urinate with. And a regular foley catheter in my penis to try to keep the opening, open. The longest I wore two was for 15 days, and there is no way to describe the pain.

Most stricture events can be cured in 2-3 attempts, i.e. Pigeon Flyer and Subic Squid here. Once they were finally fixed, no more problems. In a smaller percentage of men, it becomes a chronic condition, and difficult to control.

My record from being closed to open to back to being 100% closed was less than 30 days, despite having a laser correction as a day surgery. In that short of time, my body scarred the opening completely within weeks. My uro said he had never seen that happen so fast. He showed me photos before and after, and it was incredible that it could have closed so quickly.

And back to self-cathing, the catheters are tiny in diameter compared to a regular cath, and many doctors will give the patient lydacine gell to numb the opening to take to edge off of inserting the cath. That can help a lot if you have to do that.

I wish you the best overcoming this situation, and hope that it is short term, and not chronic.

David in SC
Age: 58, 56 dx, PSA: 7/07 5.8, 10/08 16.3
3rd Biopsy: 9/08 7 of 7 Positive, 40-90%, Gleason 4+3
open RP: 11/08, on catheters for 101 days
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos margin
Incont & ED: None
Post Surgery PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12, 4/8 .04, 8/6 .06, 2/11 1.24, 4/11 3.81
Latest: 6 Corr Surgeries to Bladder Neck, SP Catheter since 10/1/9, SRT 39 Sess/72 gy ended 11/09, 21 Catheters, Ileal Conduit Surgery 9/10

SubicSquid
Regular Member


Date Joined Oct 2009
Total Posts : 252
   Posted 4/16/2011 7:11 PM (GMT -6)   
Ouch.  Hope your problem is corrected soon.  Fortunately for me I only needed a cath for four days after each of two dilations and seven days after surgery.  So far so good.  The scar tissue has not come back.  Hope yours works out the same.  Squid.

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 4/16/2011 7:29 PM (GMT -6)   
Squid, good to see you, I was sure you wouldn't mind me invoking your mighty name.

david
Age: 58, 56 dx, PSA: 7/07 5.8, 10/08 16.3
3rd Biopsy: 9/08 7 of 7 Positive, 40-90%, Gleason 4+3
open RP: 11/08, on catheters for 101 days
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos margin
Incont & ED: None
Post Surgery PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12, 4/8 .04, 8/6 .06, 2/11 1.24, 4/11 3.81
Latest: 6 Corr Surgeries to Bladder Neck, SP Catheter since 10/1/9, SRT 39 Sess/72 gy ended 11/09, 21 Catheters, Ileal Conduit Surgery 9/10

yobiks
Regular Member


Date Joined Feb 2011
Total Posts : 39
   Posted 4/16/2011 7:38 PM (GMT -6)   
I am slightly confused- I am under the impression that in my case using the catheter is once a day as a tool to clean out any new scar tissuenot for urinating. As far as helping with the scar tissue- at the end of 6 weeks wearing the catheter- then my uro could not feed the catheter back in after  just pulling it out 6 hours previous. That day it did come out harder than the other 2 times so it seemed to be closing around the catheter. I will have to check but wouldn't you expect the catheter to be 16f or even larger to maintain a free path to the bladder?  the scope was 19f and he made the port large enough to accomadate that.
age 56
sept 28 2010
psa 2.1 ,t2b
jan10 '11 gleason 3+3 t2b
open rp scheduled march 1 2011
Both nerve bundles spared
post surgery path: t2c gleason 6
neg margins neg lymph nodes
organ contained adenocarcinoma

Northfoot
Regular Member


Date Joined Mar 2011
Total Posts : 81
   Posted 4/16/2011 8:19 PM (GMT -6)   
I can only try to answer the first part of your question. I think the daily catheterization (for me once daily times two weeks, then once every other day x 2 weeks, then once every third day x 2 weeks) was not to clean out scar (catheter too soft to do so) but rather to slightly maintain dilation of urethra. As for scarring initially, my catheter came out 2 weeks after surgery with difficulty. Maybe that was a warning that I would scar heavily down the line.

Northfoot
Regular Member


Date Joined Mar 2011
Total Posts : 81
   Posted 4/16/2011 8:19 PM (GMT -6)   
I can only try to answer the first part of your question. I think the daily catheterization (for me once daily times two weeks, then once every other day x 2 weeks, then once every third day x 2 weeks) was not to clean out scar (catheter too soft to do so) but rather to slightly maintain dilation of urethra. As for scarring initially, my catheter came out 2 weeks after surgery with difficulty. Maybe that was a warning that I would scar heavily down the line.

Paralleli
Regular Member


Date Joined Jul 2008
Total Posts : 123
   Posted 4/16/2011 8:58 PM (GMT -6)   
yobiks,

What Northfoot said. You need to google "Clean intermittent self-catheterization (CIC)". You also need to talk to your uro and ask "what am I doing this for?" I suspect it is an attempt to keep the urethra stretched out as, Northfoot noted. I had a stricture occur about 8 months after my IMRT and I read up on it and thought I would have it lasered or cut, but my uro (bless him) felt that a dilation might work as well as more drastic measures IF the I followed through. Any way a dilation, 3 weeks with a Foley, followed by CIC 3x/day for 3 weeks, 2x/day for 3 weeks, 1x/day for 3 weeks, 1x/week for a few months. After 4 years, I still do it once a month just to make sure everything is open. I'm spozed to give him a call if I can't get an 16F up there. So far, so good.
CIC is no big deal. It isn't painful and only takes a few minutes once you get the drill down. You do have to keep it clean, soap and water clean, you even reuse the catheters. Hell, I did it in the field pheasant hunting. Like many things, it really will not limit your activities unless you you allow it to.

Best....
IMRT 1/07 - Doing well.

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 4/16/2011 9:05 PM (GMT -6)   
yobiks,

an 18f (French) is the normal size cath to keep things open, as far as a regular full size catheter goes. The self-cath catheters will not do anything to prevent future scarring, but is being used, 1 - to allow you relieve your bladder, and 2 - to keep the urethra as dialated and opened as much as possible in between. that is what is typical.

david in sc
Age: 58, 56 dx, PSA: 7/07 5.8, 10/08 16.3
3rd Biopsy: 9/08 7 of 7 Positive, 40-90%, Gleason 4+3
open RP: 11/08, on catheters for 101 days
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos margin
Incont & ED: None
Post Surgery PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12, 4/8 .04, 8/6 .06, 2/11 1.24, 4/11 3.81
Latest: 6 Corr Surgeries to Bladder Neck, SP Catheter since 10/1/9, SRT 39 Sess/72 gy ended 11/09, 21 Catheters, Ileal Conduit Surgery 9/10

yobiks
Regular Member


Date Joined Feb 2011
Total Posts : 39
   Posted 4/16/2011 9:22 PM (GMT -6)   
Surely it must help to mold and smooth the surface. There were several other issues ie stone and stitch that had to be taken care of- that is why he went in with the laser.
age 56
sept 28 2010
psa 2.1 ,t2b
jan10 '11 gleason 3+3 t2b
open rp scheduled march 1 2011
Both nerve bundles spared
post surgery path: t2c gleason 6
neg margins neg lymph nodes
organ contained adenocarcinoma

Paralleli
Regular Member


Date Joined Jul 2008
Total Posts : 123
   Posted 4/16/2011 9:46 PM (GMT -6)   
Purg -

If he's only going to CIC once a day, it is not to keep the bladder empty! Emptying only once a day could cause some real problems. He needs to ask his doc, not us.
IMRT 1/07 - Doing well.

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 4/16/2011 9:50 PM (GMT -6)   
Of course, Paralleli, just giving general cath advice, doctor's orders always best.
Age: 58, 56 dx, PSA: 7/07 5.8, 10/08 16.3
3rd Biopsy: 9/08 7 of 7 Positive, 40-90%, Gleason 4+3
open RP: 11/08, on catheters for 101 days
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos margin
Incont & ED: None
Post Surgery PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12, 4/8 .04, 8/6 .06, 2/11 1.24, 4/11 3.81
Latest: 6 Corr Surgeries to Bladder Neck, SP Catheter since 10/1/9, SRT 39 Sess/72 gy ended 11/09, 21 Catheters, Ileal Conduit Surgery 9/10

yobiks
Regular Member


Date Joined Feb 2011
Total Posts : 39
   Posted 4/16/2011 10:18 PM (GMT -6)   
I was told it was to minimize scar tissue.
age 56
sept 28 2010
psa 2.1 ,t2b
jan10 '11 gleason 3+3 t2b
open rp scheduled march 1 2011
Both nerve bundles spared
post surgery path: t2c gleason 6
neg margins neg lymph nodes
organ contained adenocarcinoma
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