Surprise surgery and another infection

Last week I was logged in to my online medical records and noticed that I had an appointment booked with the surgeon who did my urethroplasty back in January. I hadn’t heard anything about it so I called the hospital and was told that it was a real appointment (not just a phone call). The letter about the appointment turned up the next day, saying they be doing uroflowmetry and with no other information.

So I drove up to the hospital on Tuesday and met the surgeon and was a bit surprised when he announced that he was going to try to do a quick urethrotomy while I was there. Preparation took a while (nobody could find the urethrotome), which was probably just as well since local anaesthetics take a while to take effect on me.

Since this current stricture was only about 3 cm in and very short he could get the rigid cystoscope in without any problems. It was interesting to watch him hacking away at the scar tissue on the screen. I didn’t feel a thing. He also had a quick look at the rest of the graft and seemed happy that it looked healthy and was wide enough to get the 20 Ch scope through.

Then I had time to grab a quick lunch before meeting a nurse to be instructed in how to do clean intermittent dilatation to keep the stricture open. I got some supplies but I’ll have to contact my local urology clinic for more, since I’ll be doing it daily to start with.

I’d managed to pee normally a couple of times at the hospital. There was a fair bit of blood but the local anaesthetic was still working, so it wasn’t painful. By the time I got home the anaesthetic had worn off. While I was actually peeing there was a burning sensation, which I expected and it was bearable, but afterwards I got rapidly increasing intense pain. This was really about the worst pain I’ve ever experienced, I nearly blacked out sitting on the toilet. The pain gradually faded away over a few minutes.

My husband brought some local anaesthetic gel and I took some strong painkillers but nothing seemed to help with the horrific pain every time I peed that afternoon. To make things worse my bladder was still irritated from the pressure due to the stricture so I was peeing quite often.

Then as the evening went on I started to feel worse and worse, achy and feverish. My temperature had got up to over 38°C, so my husband called a taxi and we went to the ER. I got seen fairly quickly, gave the same information to several different people and they took various samples. By around midnight they’d decided it was a post-operative infection and to keep me in but they couldn’t find a bed for me for several more hours and it was about half past three before I eventually got up to the ward.

The antibiotics seemed to start working pretty quick, so I was already feeling better yesterday and got to go home for the night. I went in this morning for the final dose of IV antibiotics and they’ve discharged me with antibiotic tablets.

So now I just have to see how I get on with the dilatation. It seems easy enough to do and the surgeon reckons that after a few months I should only need to do it once a week. I’m a bit concerned that that’ll be once a week forever but I could live with that.

Follow-up appointment

I finally had my follow-up appointment today. I mostly wanted to ask about the curvature, twist and pain of my erection and the continuing strange sensation in parts of my foreskin, where some patches are almost numb and others that feel like they’re sunburnt).

The first step, as usual, was uroflowmetry. I peed into the machine and returned to the waiting room. Then the nurse came back for me and took me to an examination room where she measured the remaining urine in my bladder with the ultrasound device. There were 90 ml remaining, although some of that might have been new as I’d had a lot to drink in the morning to make sure I could pee on demand.

After a while a junior doctor appeared, yet another one I’d never seen before. He told me that although the shape of the curve now looked normal the maximum flow rate was too low and they’d do a cystoscopy to check out what the problem was.

I wasn’t all that keen on the idea, knowing that cystoscopies have a relatively high chance of causing further damage. I was happier once I heard that one of the surgeons who’d performed my urethroplasty would be there.

After all the usual preparation, including two large doses of local anaesthetic gel squirted up my urethra, the endoscope went in.

The good news is that the graft is looking nicely pink and healthy. The bad news is that there’s a stricture where the graft joins the original urethra on the side towards the bladder. That has partially blocked my urethra at that point, although not enough to be very noticeable. You could just about see past the stricture to normal urethra on the other side, so it wasn’t very long at all, just a millimetre or two.

The doctors discussed with each other, with the nurse and me occasionally reminding them that I was there, and decided that I should try dilating the stricture for six months or so to see if it helps. That’s another thing I wasn’t keen on, knowing that dilation has an extremely poor success rate and can actually make things worse.

The nurse disappeared off to get a selection of different sizes of catheters to work out what size I should start with. I endured the awkward chit-chat and then silence with the senior doctor.

In the end only a number 8 catheter would pass through, after several attempts by both the nurse and the surgeon. It seems that there’s a sort of little pocket formed by the graft that kept catching the catheters and there’s no way I’d be able to get any useful size up there myself. They were hoping to start with at least a 12 and work up to a 16.

So now I’m waiting for an appointment for another urethrotomy.

This isn’t entirely surprising. Small, thin strictures of this kind are apparently common after urethroplasty. All the research I’ve seen suggests that the chance of recurrence after urethrotomy is low, I’m just kind of disappointed that the whole thing isn’t over yet.

One option I’m sort of considering is to hold off on the urethrotomy and see if the stricture gets any worse. I can live with it in its current state. I’ll have to read up on things a bit more and think about it.

And finally, the things I originally wanted to ask about (wonky erections and odd sensation) are all quite normal and related to scar tissue and regrowing nerves. I need to be patient. Also, erections are apparently good for stretching the scar tissue.

First investigations

First I got called up to the hospital for a CT scan, to make sure the blood wasn’t coming from my kidneys. It wasn’t, so I got an appointment at the urology clinic. By this time it was the end of June.

Before my appointment I had to record frequency and volume of urination and (separately) how long the first 100 ml of urine took. My trip to the clinic started with uroflowmetry, peeing into a machine that records the volume of urine over time. That showed that there was definitely something wrong, the flow was way too low.

The doctor then did a cystoscopy, or at least tried to. He only got a couple of centimetres in before hitting a blockage, with only about a 1 mm passage through it. That explained the difficulties.

He then said he’d have me scheduled for a urethrotomy (DVIU), without really explaining anything about the procedure. He seemed more concerned about the difficulties of scheduling it, with very little time left before everyone went on their summer holidays, than talking to me. Unfortunately that turned out to be a pattern in the urology department. They didn’t do any further investigations of how long the stricture was.