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DrVasavada
DrVasavada, Doctor
Category: Medical
Satisfied Customers: 4557
Experience:  MD(Ped), DCH ; in practice treating adolescent to newborns
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I have a past medical history of Kidney stones. For the past

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Hi Doctor,I have a past medical history of Kidney stones.For the past 4 years I have been having urinary problems, whereby I am not completely voiding and due to that it feels as though I have continue to visit the bathroom and can't void again right away and I have to wait until there is enough pressure for me urinate the 2nd time round.Last year I decided to visit the Urologist and seek medical help with regards ***** ***** issue I have currently. The urologist decided to do a uroflowmetry and the results were abnormal. If a i remember correctly the flowrate was 10ml per second, to which the urologist stated that there is a good chance that I have stricture.He booked me for a cystoscopy procedure under general anaesthesia, but, due to Covid the procedure never went ahead and the hospital never really got back to me.I decided to visit a different hospital and they did a uroflowmetry and the result according to the discharge summary was voided a good volume but , a lot of the volume was still inside the bladder after they did a ultra scan.I have now been booked for a cystoscopy +/- with a procedure named DIVU (Direct visual internal Urethtromy. After reading numerous articles from various sites and also visiting various forums, it seems as the success rate is really low. According to my understanding is that if a stricture is below 1CM and depending on the location, then DVIU has around 50 /70%, and, if the procedure is done multiple times, then the success rate reduces significantly to around 7% , as per my understanding.Also from what I gather is that after that procedure is completed and the catheter has been removed, one would be required to ISD (Intermittent self dilation, which would be done once a week or something twice depending on circumstances. If dilation is not done as per advise, then the stricture is likely to return ever quicker and cause complete blockage, whereby one can't urinate. Which would then require medical attention.The problem I have in doing this procedure is :1 - The glans on my Penis are very sensitive, including the meatus itself
2- Because the procedure requires self dilation, I don't think I could be able to dilate urethra because it would be painful and not only that, I would probably end up creating false passages because of this.I spoke to my GP and requested that I should have Urethroplasty done as it has long term success and also it would eradicate the need for me to have to dilate each time.The GP has advised me that I should still go and have the cystoscopy done as this way can have a look inside, but inform the urologist that not to do the DVUI. And then discuss with the urologist what is the best method for this.The GP quoted that the Urethroplasty is done on a last resort and that the first procedure is usually Dilation or DVUI.The question is:1- Is urethroplasty the last resort?
2- What would be long term damage if I never get this fixed?
3- Was I correct with regards ***** ***** I have stated with regards ***** ***** & self dilation?
4- What would be the cost in the UK for urethroplasty , if I was to get it done privately & would they do the open surgery as a first resort or would they also state the same as what the GP quoted?
5- When a cystoscopy is being done, do the urologist force the scope through the Stricture if there was on present at the point of Entry? Because, if they do that, would it not aggravate the stricture and cause it come back quicker and longer next time ?Many thanks in advance and I await your reply. I hope the above makes sense.regards,
Hello,

I've been working hard to find a Professional to assist you with your question, but sometimes finding the right Professional can take a little longer than expected.

I wonder whether you're ok with continuing to wait for an answer. If you are, please let me know and I will continue my search. If not, feel free to let me know and I will cancel this question for you.

Thank you!
Customer: replied 19 days ago.
I am ok with waiting for an answer. I hope you will be able to find a professional before Thursday 10th June

You have a complex problem and many ifs and buts. Still one can go ahead with procedure. One can take up problem each at a time as it arises. Open plasty procedure surely is best but very complex and still stricture can develop at site of operation. Meanwhile try using pyridium for symptomatic relief to reduce urethra sensitivity.

Good luck.

DrVasavada, Doctor
Category: Medical
Satisfied Customers: 4557
Experience: MD(Ped), DCH ; in practice treating adolescent to newborns
DrVasavada and other Medical Specialists are ready to help you
Customer: replied 17 days ago.
Hi Doctor,Many thanks for your reply.I will certainly speak to urologist with regards ***** ***** sensitivity related issue of the Meatus and asked them to prescribe the medication which you have named.My biggest issue is that if they do the Dilation or DVUI, then as far as I understand is that ISD is required post OP.
This is where I struggle with, as I do not think I can be able to perform this on my own without possibly causing injury and making matters worse. Which is why I feel Urethroplasty would be the best option. What would you suggest?
Customer: replied 17 days ago.
Hi Doctor,Spoke to with the urologist and he has quoted that I should go ahead and get the procedure done. He stated because at this time, it is a suspected stricture, there is no point in thinking about the future.So I have come to the conclusion that I will go ahead and have the procedure done. He stated should it come back again, then he would refer me for a urethroplasty.So what you stated was spot on!Many Thanks.