uretheral stricture

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    DLC
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    Posted: Sat Jan 31, 2004 2:25 am Post subject: Recurring Urethral Stricture

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    My friend's 'S father aged 65years is suffering from urethral stricture (post catheterisation) at bulbomembrane part. We understand that you are one of the accomplished medical practitioners to treat urethral stricture. Thus, we would like to know the following:
    1) Type of treatment you suggest hereon (short term or long term solution)
    2) Any diagnostic tests to be undertaken at this point of time?
    3) Expenses involved in the same?
    4) When can the treatment commence?
    5) How are the chances of curing this ailment permanently (I mean success rate of / recovery period from the procedure you would possibly undertake)?

    Case History
    He has had this fear of injections / hospital and was not hospitalised ever before, until 3-and-a-half years back in October 2000 when he suffered from tetanus after a prick in the toe from a rusted roadside nail (did not take an injection of TT thereafter) which pierced through his shoes. Within 10 days lockjaw like condition prevailed and he was admitted for treatment of tetanus. An attempt to put in a catheter failed for the first time in the government hospital three days after admission, but he was catheterised in the second attempt. After about 17 days, when he was cured of tetanus and the catheter was removed just before discharge (some say the nurse had been careless), there was abnormal and huge amount of bleeding which even put the attending doctors on alert. Unfortunately, there was no urologist and the attending doctors asked the nurse to put back another catheter after dressing. He was kept back at the hospital for another 2 days and discharged, the catheter still in place.

    During his stay at home, again heavy bleeding occurred while the catheter was still inserted. The bed sheet was drained with blood. Urologist was called for and he changed the catheter after dressing. 3 weeks later the catheter was removed and no bleeding occurred. Hytrin was prescribed by the urologist. That was October / November 2000.

    He started having obvious urinary problems since January 2001. Frequency of urination increased and there was lesser control too, with problem of reduced flow. Another urologist now diagnosed the problem as Urethral Stricture post catheterization at bulbomembrane part based on an ascending urethrogram in March 2001. He advised Optical Urethrotomy but my father again could not think of hospitalisation & surgery and continued Hytrin alternatively but it was of no help.

    He started taking homeopathic medicines from March 2001, but the problem was turning from bad to worse. Our homeopathic doctor does not prescribe medicines, rather he gives his dosage (globules / powder, etc) himself in small packets, to be taken two days in a week empty stomach. Thus, at this point of time, we wouldn't know the names of the homeopathic medicines administered. Our homeopathic doctor is a very close relative of ours (more than an elder brother to me). We have been very strong followers of their homeopathic medicines (his father's and now his) since childhood and all family members got treated for almost all ailments they suffered from very successfully. My father did not have to take homeopathic medicines previously, because he did not suffer from any such chronic disease. They do not charge any professional fees or money for medicines from us, thus it can very well be estimated that he's been trying hard to cure the same.

    Problem persisted with very less control over holding of urine, extremely poor flow / dribbling and higher frequency with longer duration in the lavatory resulted. And that satisfaction of emptying the bladder after urination was never there.

    In June 2002, there was no passage of faeces / flatters for 3 days and the general physician diagnosed the problem as obstipation. Repeated enema's and tablets failed to solve his problem. After about a week, the root problem detected was full bladder with overflow of urine from the bladder.

    He was admitted to hospital for catheterisation but catheter could not pass through. Various tests were conducted thereafter. Report showed: Blood Urea (32.1), Creatinine (1.6). USG of abdomen revealed that the both kidneys appeared slightly bulky with mild increase in cortical echogenecity - and fullness of the collecting system was noted in both kidneys. Urinary bladder was distended with thick walls - no intraluminal SOL, calculus or diverticulum was seen, but the post void residue was significant (360 cc). Both ureters were dilated. Prostrate was mildly enlarged and capsule was seen intact and no calcification or cavitation was seen inside prostatic parenchyma. Doctors said all were on the higher side and would get back to normal once the bladder would be empty. Urologist suggested cystoscopy / urethroscopy & internal urethrotomy and that such a situation should be avoided in future by timely dilatation else it will affect other organs.

    Cystoscopy and Internal Urethrotomy were performed in first week of July 2002. Post urethrotomy, catheter was there for 3 weeks and clamping was done. Hereafter, the urologist indicated that the bladder was empty, there was good bladder sensation and periodic dilatation was suggested.

    Dilatation Records
    1) 25-07-2002 Urethral Dilatation done and good flow observed.
    2) 29-08-2002 Urethral Dilatation done - Rugged urethra bleeding ++
    3) 21-11-2002 Urethral Dilatation failed - Very spongy, urethra bleeding ++. Again admission for cysto urethroscopy suggested.
    May need internal urethrotomy and self dilatation by catheter everyday observed the urologist.
    4) 29-05-2003 Urethral Dilatation done.
    5) 15-07-2003 Urethral Dilatation failed. May need urethroplasty feels urologist.
    6) 01-11-2003 Urethral Dilatation done with difficulty. [Dilator up to 12/15]
    7) 27-11-2003 Urethral Dilatation done - (patient does not get a feel good factor as with successful dilatations before) - Stricture
    about 3 cm long assesses the urologist. Admission for cysto urethroscopy and internal urethrotomy suggested.

    Dilatation was performed alternatively by a couple of urologists. One could do it successfully only once after urethrotomy and failed later, while the other did it with difficulty but successfully.

    After a successful dilatation there is a feel good factor, but the recurrence of the problem is there within one month's time or even less. There has been no pain, irritation or bleeding during urination except immediately after urethrotomy and 2/3 days post dilatation.

    All this time homeopathic medicines are still on and many Urine R/E and Culture tests were undertaken and most of the times urine was infected with either E.Coli, Klebsiella Aerogenes or Proteous Mirobillis which the urologists say is but natural. Urea: 24, Creatinine: 0.9, Uric Acid: 5.9 and PSA: 2.95 ng/ml as per last tests quite sometime back.

    Now the problem is back to square one, with very lesser control over holding of urine, poor flow and higher frequency with longer duration in the lavatory these days.

    Possible Remedies / Suggestions of Urologist
    Urologists are of the opinion that dilatation every 3 weeks or monthly in the long run is not very healthy for any patient. Thus, they suggest the following:
    1) Cystoscopy and Internal Urethrotomy followed by dilatation monthly or earlier for 3 months. Thereafter, bi-monthly dilatation three times and half yearly thereon, if all goes well.
    2) Cystoscopy and Internal Urethrotomy followed by use of Silicon catheter for 4 months which would restrict formation of scar and periodic dilatation thereafter.
    3) Urethrogram followed by Urethroplasty - One stage / Two stage urethroplasty

    Apart from the above, while trying to understand the ailment my father is suffering from, I got to know of some other options as well. One of urethral stent and another laser treatment.

    I understand biodegradable spiral urethral stents have been used with favorable results for recurrent urethral strictures. But it has complications such as migration of the stent.

    I learnt that laser treatment of following types is available:
    1) Ablation of urethral stricture by the use of contact Nd:YAG laser.
    2) 980-nm Diode Laser Treatment for Recurrent Urethral Strictures
    3) Evaporation of urethral strictures by use of Argon laser.

    What are your views on the same? And any remedy which permanently removes the problem will be helpful.

    Thanks for your patience and diligence to read this far. I eagerly await your response.

    Thanks & Best Regards,
    DLC




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    Friend
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    Posted: Fri Feb 13, 2004 8:12 pm Post subject: Got it.

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    Dear DLC ,

    First of all i would like to ask u whether u r related to field of medicine or whatever u have written is directly from ur father's reports. This will help me in comprehending myself depending upon ur understanding of the subject.

    Also, from whatever u have written in ur post it seems that u have never sought expert help in a good tertiary level hospital over the past 3 yrs. or so.

    Do post a message telling about urself & also write about whether ur father is suffering from any additional medical problem or not.

    Will get back to u after ur reply.

    Friend.




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    paulc
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    Posted: Mon Oct 18, 2004 9:14 pm Post subject: urethral stricture

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    this is al still new to me but i had a dilation done 4 weeks ago which failed and have had a superpubic catherter fitted until i see the specialist in 3 weeks time.

    Ive done some research into the area and the studies on laser treatment seem the most encouraging using a a Nd:YAG laser.

    I am looking to see if any hospiatls in uk use this laser now and will inform u if i do find anywhere.

    best regards Paul c




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  2. Guest

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    gdfgdfgd
  3. Guest

    Guest Guest

    about urethral stricture completete cure

    i m ayurvedic doctor i hv done many cases of urethral stricture with uttarbasti therapy,
    we have found encouraging resultsof it with no recurrence my email id sunil_ayurveda @yahoo.co.in

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