Expert: Arthur Goldstein, M.D. - 10/20/2005

Question
Hi Dr. Goldstien. I questioned you earlier concerning a stricture:

http://experts.about.com/q/989/4106015.htm

I followed up later, but you were not available, thus I asked Dr. Leslie:

http://experts.about.com/q/989/4138455.htm

As of 10/13/2005, I have completed a urethroplasty(I'm not sure of which specific one it is called at the moment, but it was one where they took skin and grafted it to the urethra - the stricture was approx. 2.5 cm and located directly in the curved part of the urethra ).

I have some questions(which I have tried to ask my surgeon, but while he is apparently a very widely respected and experienced surgeon with a huge number of published journal papers under his belt, he appears to be a terrible doctor so far as communication with me after surgery and in some other aras, so I am having to ask other doctors for this information):

1. I have to(or told I have to) wear the cathetar pulled upwards and taped to the abdomen so that the penis basicly lies flat against the adomen. Why is this specific taping method required? This is very painful for me, regardless of different ways I have tried. Despite the warning, I am not wearing the cathetar with force pulling it upwards as of today, due to the intolerable level of pain I experienced.

2. I am told that the cathetar needs to be in place for over 3 weeks(!). Is this standard? Or just a preference of the surgeon? I have tried to get the surgeon to shorten this time; please see question no. 1..

3. I had a graft where they removed skin from my penis(which was already circumsized, and this was done WITHOUT my permission -- it was told to me that they would be using skin from my inside mouth cheek, and the surgeon inspected the cheek skin prior to surgery to ensure it was good). After 1 week(I know this is still short term and I would not really want sexual excitation, but please read on for relevance) I have no desire sexually and an erection has not been possible, except for a nocturnal very limp/partial one where the shaft got somewhat stiff and the head remained soft with no erection at all. Is this a normal reaction after this type of surgery?

4. I feels like a have a very thick ring in the front half of my penis near the base. Maybe a swollen or clotted vein? Should I have this immediately inspected by a urologist?

5. My urine, after several days, now has a strong sweet smell. Is this normal(my diet has not changed and refer to the drugs I was taking in the next paragraph)? Should I get a urinanalysis?



Off topic, but just a commentary for other readers, and for your personal curiousity: I am already sorry that I had this surgery. The violation of my penis without my consent is tearing me up, mentally. I have already had some initial consultations with attorneys concerning this unauthorized action. When I asked the doctor 'why', he said that he just decided to use that skin since it looked like there was enough(which BTW, I don't think that there was -- I have the type of penise that is very short when flacid, say 1-1.5", but when erect, grows to almost 6". The erect penis was already very tight skin. It appears that they took about one third to half the flacid vertical length of skin along the rear of the penis shaft.) I was highly reactive to 3 of the 3 medications(oxycodone, ketoconazole, bactrim) that I was prescribed to the point where I ended up having an ambulance take me to the E.R. due to the extreme reactions at one point. All of this for a stricture which only ocassionally bothered me, and that was probably self-treatable with a cathetar in the rare times that it did flare up. Thank you for taking the time to answer my questions(also, please feel free to give any advice as you see fit in response to my off topic commentary).

-Chris  

Answer
Christopher, the answer to your questions follow:

1.  The catheter is taped to the lower abdomen to keep the urethra straight.  If the penis hangs in its normal position, the bulbous urethra (the area you were operated on), angulates and there can be pressure of the catheter on the graft.  This could potentially cause damage to the repaired area.

2.  Leaving the catheter in for several weeks is routine. This is done to divert urine away from the grafted site and to ensure an adequate caliber urethra as there is always some degree of graft shrinkage.

3.  The choice of donor site for the graft is something you must discuss with your surgeon.  Using penile skin is common.  It is normal after surgery to have a lowered libido.  Taking a skin graft from the penis should not interfere with either your potency or libido once you are healed.

4.  If you have a concern about the thickening around your penis, by all means have your surgeon look at the area.  Most likely is it normal postoperative swelling as you are only 1 week post-surgery.  

5.  While there, it would be reasonable to have your urine checked for infection.  While you have the catheter, you should drink extra fluids in an amount sufficint to ensure a urinary output of at least 2 liters (quarts) daily.  This will reduce the likelihood of infection and help to prevent formation of crystals that could block the catheter.