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Urethral stricture advice

i am a 41yo wm. discomfort during urination started when I was an adolescent and has been there on and off ever since. was diagnosed in my 20s with chronic prostatitis and have taken antibiotics for that a couple time in my 20s and 30s. the last few years my urine stream has gotten narrower but i could live with it. for the past 6-8 months i've started having more pain at the tip when urinating and some cramping in the pelvis.
i had a few dribbles of blood-stained urine one day about a month ago so i went to my family practitioner 2 days later. he did a urinalysis which showed no blood, but ordered a pelvic CT. they only did a non-contrast because the medical imaging people were not aware of my allergy to shellfish. the CT showed nothing in the kidneys but my bladder wall was thickened and there is some prostate calcification however, the radiologist and urologist didn't identify those as anything pathogenic.
because there was some blood the urologist set up a cystoscopy to take a look but hit a stricture in my urethra and couldn't get the scope through. he immediately set me up for a DVIU to repair the stricture, which will take place in a few weeks.
1) should i ask for any more testing prior to this procedure (e.g., urethrogram to show the length & location of the stricture, or is it standard to order the DVIU without it?
2) given the 40-50% success rate of repair with DVIU, if it's a size or location not typically responsive to DVIU, is it ever prudent in any case to skip right to urethroplasty? i lead an active physical life and would prefer not to have ongoing, multiple procedures and would be especially averse to self-catheterization
3) given that my urethra is currently strictured, but functional (i had about 1 tbsp of urinary retention prior to the cystoscopy), is there any risk that post-DVIU stricture recurrence could result in acute urinary retention?
4) any other feedback or comments would be welcome as well
2 Responses
Avatar universal
How are you? Complication of Direct vision internal urethrotomy (DVIU),  a surgery to repair a  urethral stricture, is usually rare but possible. Possible complications such as abscess or damage to urethra, recurrent stricture, dysuria, erectile dysfunction, bleeding, injury to surrounding tissue and reaction to anesthesia may occur. Risk factors that may increase the risk of complications include: bleeding disorders, obesity and smoking.  Prior to the procedure, the attending physician usually conducts a complete physical examination and may order imaging, blood, and urine tests. Also, the anesthesia to be used and the potential risks is also discussed. It is best that you discuss the procedure with your doctor to ease any anxiety and to have a better picture of what to expect. Factors such as your medical history, age, how well you tolerate the procedure, among others are important considerations also. Take care and do keep us posted.
Avatar universal
Hi. Thank you for your feedback. I had the procedure just over 72 hours ago. Using DVIU with general anesthesia, the urologist made a single cut through a 1cm stricture located in the membranous urethra 1 cm below the sphincter. It took 16 minutes to complete. I removed the catheter several hours ago and the results so far have been great -- the blood that was present with the catheter has been washed away by a urine stream more powerful than I have ever had, even as a child. I am passing clean urine which appears to be free of blood or drainage. Pain has been minimal throughout. I never filled the painkiller prescription. There is some discomfort when i sit in certain ways or move in my chair, but it's steadily improving. The urologist suggested my stream will be powerful at first and will gradually slow down, but the goal is for it to be better than before. The literature suggest about a 50-50 long-term success rate for strictures the size of mine. Based on my procedure being well-tolerated and the size and location of the stricture, does 50-50 seem about right? I am hoping to beat those odds!
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