What Causes Inflammation And The Bloody Discharge After Laser Surgery For Urethral Stricture Disease?

Posted on Mon, 20 Jan 2014

Question: I have urethral stricture disease. Usually, my urologist does laser surgery periodically and then puts a Foley catheter in for a week. He is one of the top urologists in the state snd I credit him for saving my life. He built his own dedicated urology clinic and I had a procedure done in October and was delighted. However, insurance noe says it won't pay him unless he's 30 ft away in his opting office. On Friday he had to open my peehole with a cystoscope and cut scar tissue with an instrument of some kind. Forlorn in for a month. There was a lot of blood this time, which he said was normal. Now there's bloody mucus around where the XXXXXXX goes in. I called him. He said it was normal. It's not pussy, it's mucosa. Urine flow is good, clear, no pain. Is this because it wasn't dine with a laser this time?

Answered by Dr. V. Sasanka (1 hour later)

Brief Answer: Most likely not significant Detailed Answer: Hi, Thanks for your query. What you have described is a fairly common situation as urethral stricture disease almost universally recurs, and most patients give history of recurrent visits to their urologists. What has been noted is that the severity of disease depends on what is known as spongiofibrosis - i.e. scarring in the tissue surrounding the inner delicate layer. This fibrosis will only get worse with repeated procedures, irrespective of what you have used to incise the stricture with - it could be laser or metal knife - So I guess this probably answers your question. When a catheter is left in for some time, it excites some mild inflammation, and the discharge which arises from this usually comes out by the side of catheter. this not XXXXXXX and in fact, welcome, as several attempts to reduce the peri-catheter discharge by placing larger sized catheters have only caused more damage to the urethra. One suggestion that I could also give at this stage is - to discuss with your urologist the option of ' urethral clean self-dilatation'. This will not remove the disease but makes it more manageable, especially if you could be having problems with Insurance. Depending on your disease extent which is assessed by means of an X-ray called retrograde Urethrogram, you can also discuss with the urologist the option of a more permanent solution such as Urethroplasty using buccal mucosa or having him place an opening in the perineum which is not a bad option at all considering that you are now 63 years. Please let me know if you have any further doubts, and I shall be happy to clarify. Regards.

Above answer was peer-reviewed by : Dr. Raju A.T

Follow up: Dr. V. Sasanka (22 minutes later)

Thank you for your detailed response. Since the procedure had always been done with a laser, ther has usually been little blood. Then discharge is from the side of the opening. What is urethral clean self dilation?

Answered by Dr. V. Sasanka (7 hours later)

Brief Answer: Reduce stricture by self catheterization Detailed Answer: Hi again, Self catheterization would involve your learning to pass a soft, easily flexible catheter into your urinary passage. The idea is to dilate the track and stretch it while not causing any rupture of inner mucosa which will allow healing. This can be learnt very easily, and would involve about a minute of your time every day. We say 'clean' meaning you can re-use the same catheter for several days and this has been found to cause no appreciable increase in urinary infections compared to a sterile technique where you throw away the catheter after a single use, which can get a bitexpensive. The idea is - imagine your urethral lumen to be having a diameter of 30. Until it becomes less than 12, you do not develop any symptoms of slow flow. So we try and keep it well above 14 or 16 with a No. 14 or 16 catheter so that the lumen does not come down to 12 or should it ever come to stage where the catheter cannot be passed, you can consult the urologist who can do a dilatation easily as an outpatient rather than go through the whole rigmarole of laser optical urethrotomy, thus saving you time and money. All the best - please let me know how you are doing. Regards.

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Above answer was peer-reviewed by : Dr. Raju A.T