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Dr. Andrew Rynne

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Suggest treatment for urethra blockages from scar tissue

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Dr. Shoaib Khan

General & Family Physician

Practicing since :2009

Answered : 9409 Questions

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Posted on Mon, 25 Aug 2014 in Urinary and Bladder Problems
Question: My friend had prostate cancer that was treated with radiation, hormones, and radio active seed implants. this was performed about 10 years ago. Currently he experiences urethra blockages from scar tissue at the entry point from his bladder, The doctors have extreme difficulty inserting a catheter. He had to have surgery to cut the scar tissue and relieve his ability to urinate. This procedure was repeated every six months as his ability to urinate decreased to a dribble. Now, this routine is down to every three months. Is there any new procedures that can give him a more permanent solution. Note: I too had prostate cancer and received the same course of treatment five years ago. Medical procedures improved when I had prostate cancer. Fortunately, I have returned to normal urination and have been cured. Can you recommend anything I can relate to my friend?
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Answered by Dr. Shoaib Khan 1 hour later
Brief Answer:
One solution does come to my mind

Detailed Answer:
Hello sir and welcome.

Thank you for writing to us.

I have gone through your query with diligence and would like you to know that I am here to help.

Of course, you do understand that your friend's situation is quite unique and complex as well. You also need to understand that a surgical procedure in itself results in the formation of scar tissue. So, the more often a surgery is performed, more are the chances of an increased percentage of scar tissue and recurrence of scar tissue formation.

In my opinion, instead of going ahead with surgical options, there does exist a more simple solution which can be tried: Permanent suprapubic catherters. These help in draining urine directly from the urinary bladder, not requiring a healthy urethra at all. Why don't you suggest the same to your friend. Of course, quality of life in comparison to what he is currently leading should improve. You could do a little research about the same and speak with him and his doctors.

I hope you find my response helpful and informative. For now, this is the only solution I could really think about. Of course, permanent suprapubic catheters do carry the risk of infections, etc; but it would be a solution we can easily tackle. Please also feel free to write back to me for any further clarifications, I would be more than happy to help.

Best wishes.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Shoaib Khan 4 days later
Hi Dr. XXXXXXX
Your suggestion is interesting. Is this suprapubic catheter inserted through the penis? does it have a valve to permit draining, or does the user have to wear a bag for draining? Does this catheter have to be exchanged every so often, like on a monthly basis, or is it semi permanent? How does the patient guard against infection? How is infection controlled?

My friend's doctor Zito advised him of a procedure where he could have a catheter inserted and held in place using the extra skin at the head of his penis. My friend was never circumsized, which facilitates this procedure. But, how does the patient control the flow of urine? Dr. Zito said that the catheter would have to be changed every month to avoid infection. Is this procedure what you had in mind?
doctor
Answered by Dr. Shoaib Khan 7 hours later
Brief Answer:
Not the same as you are picturing sir

Detailed Answer:
Hello once again sir.

A suprapubic cathether is inserted through the region where the pubic hair grows directly into the bladder, and not through the penis. One end of the catheter is placed into the urinary bladder and the other is attached to a urine bag, so drainage takes place automatically.

There are semi-permanent suprapubic catheters (made of silicon) which can be used for a duration of 6 months to a year. These silicon catheters have reported a lesser chance to the development of infections, and further infections can be avoided by practicing good hygiene and also learning how to care for a permanent catheter which the caring nurse of doctor will advice you on.

I am guessing Dr. Zito had a more permanent urethral catheter in mind, which is placed inside the penis. So this is not what I had in mind sir.

And flow of urine need not be controlled by the patient as the pressure gradient promotes automatic drainage of urine.

I hope you find my response helpful sir. I also hope I have explained things to you in a manner best understood by you. Please feel free to write back to me for any further clarifications, I am always available to help.

Best wishes.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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