AboutStephen W. Leslie, MD Expertise Questions concerning erectile dysfunction, kidney stones and prostate disorders including prostate cancer. I have a special interest in kidney stone disease prevention.
Experience Full time practicing urologist with 20 years experience. Assistant Clinical Professor of Urology at the Medical College of Ohio. Editor in Chief of eMedicine Urology internet textbook. Author of only book written for patients by a urologist on the subject of kidney stones "The Kidney Stones Handbook". Inventor of the "Parachute" and "Escape" kidney stone baskets and the "Calculus" stone prevention analysis computer program.
Organizations American Urological Association, Ohio State Medical Association, Sexual Medicine Society
Publications Men's Health, Journal of Urology, Urology, Healthwatch Magazine, Emergency Medicine Monthly, eMedicine, "The Kidney Stones Handbook", and numerous articles in various newspapers. He is also the editor of the Urology Board Review by McGraw-Hill used by urologists to study for their Board Certification Examinations.
Education/Credentials Graduate of New York Medical College with residencies completed at Metropolitan Hospital New York, Albany Medical Center and University of Wisconsin-Madison
Awards and Honors Thirlby Award of the American Urological Association.
Question Thank you for the prompt answer. I should add one bit of information that I forgot to state: On both occasions where they inserted a cathetar, it initiated very difficult urination for several days afterwards. I don't know if this is relevant, but seeing as it seems a cathetar in a way would somewhat dialate --- the effect here seems backwards as to what would be expected[reduced flow afterwards instead of increased flow]. Anything to this so far as probabily of prostate as opposed to urethra?
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Followup To
Question -
Hi, I recently submitted a question to Arthur Goldstein, M.D. on this site and had it answered.
Unfortunately, Dr. Goldstein is currently at 'maxed out' status and it not answering questions.
I have now had a succesful retrograde urethrogram and a stricture that is 2.5cm located right after the general region of the prostate. The surgeon wants to [ and has planned ] a urethroplasty. However, I am questioning if this is the right thing. Note: I am able to get what I consider a satisfactory stream rate for periods of a week, and then it gets very weak for a day or two[with the past incidents of not being able to urinate at all] and then the stream starts to get stronger once again. Does/can the stricture itself actually obstruct in a variable manner? Or is this variability probably prostatitus? Additionally, it should be noted that it is painful when I ejaculate around the times of the weakened stream. As well, urination is more painful after ejaculation. Sometimes some of the ejaculate has a pinkish tint. Please give me your opinion and the questions I should ask my doctor. Obviously, the last thing I want to do is open surgery. Thank you in advance for any advice you can offer me.
Answer -
So I'm your second choice, huh!
The usual treatment for such a stricture would be a Direct Vision Internal Urethrotomy or DVIU. This involves cutting the stricture with either a laser or a cold scalpel blade. If often heals open but not always. This is probably worth a try before considering an open surgery.
Such a treatment may not be possible depending on the exact location.
Variations in urinary stream are quite common and you cannot make any conclusion based on that fact alone. This is not a lead pipe where the flow rate and pressure are constants! While prostatitis is possible, it is unlikely in view of the information presented.
We like to make sure that the stricture is "mature" before doing any surgery.
Regular intermittent self dilation is another option that would keep the are open but still avoid surgery. Ask your physician about this.
Open urethroplasty is essentially plastic surgery on the urethra. Most community urologists do this only rarely. Best results are obtained when urologists and plastic surgeons work together. Even better, see a urologist with experience and/or fellowship training in penile and urethral reconstruction.
Best location in US for such a surgery would be Norfolk VA. Consider going there for a second opinion prior to any open surgery. They're the leading experts on these conditions.
Answer There is insufficient information to offer a definitive opinion. Logically, after catheter dilation the flow should be improved. If it isn't, then some other rationale must account for this. Prostatitis might but it doesn't fit the other information you provided.
Why don't you just ask your urologist who is more familiar with your situation?
