Stricture at Bulbar after HDRBT and IMRT - Seeking Advice

[akaipop3ps]

A G9, had both HDRBT and IMRT in 2017. Also, ADT (Eligard and Zytiga) ended on January 2019. I am in SoCal.

March of 2019 had a complete blockage and it was a stricture at Bulbar, Uro did a Direct Visual Internal Urethrotomy and it has been good for about 15 months now.

Last week had a cystoscopy due to blood in urine, Uro said the stricture is back and recommended a Urethroplasty (its a surgery). However, based on a study that I found, people with stricture after Radiation Treatments do not heal very well and the success rate is quite lower than people that have not gone through Radiation Treamtnes.

I am looking for advice or recommendation on this issue as some of our members may have either first hand experience or have come across this issue second hand.

Thanks very much.

MP

[Tall_Allen]

Is the problem due to overgrowth of scar tissue?

[akaipop3ps in reply to Tall_Allen]

Allen, not sure as to the exact origin or cause of the stricture, uro did not say.

Below is the study that I found regarding lack of long term success of urethroplasty in the patients who have been treated with Rad Therapy. I am a bit uncertain now after reading the study, unfortunately, there isn’t much alternative.

Another issue is making sure that the surgery is performed by an experienced surgeon specializing in reconstructive urology.

Yelp doesn’t have much review in this area

ncbi.nlm.nih.gov/pmc/articl...

[Tall_Allen in reply to akaipop3ps]

That study is about stricture imaging - is that what you meant?

The reason I asked about scar tissue is that there are collagenases (Xiaflex) that can be injected into scar tissue to dissolve it, The problem with cutting scar tissue is that it can grow back more than before, which may have happened to you.

[fluffyfur]

Hubs has a bulbar stricture after RP and we are seeing a top stricture specialist at MD Anderson that only works on stricture disease. PM me if you'd like his name.

Here is one of his recently published articles. ncbi.nlm.nih.gov/pmc/articl...

[akaipop3ps]

Sorry, I attached a wrong article.

ncbi.nlm.nih.gov/pmc/articl...

[akaipop3ps]

I am in Southern California.

[Chask]

I can’t comment on stricture surgery other than to say neither my regular Uro or the specialist stricture Uro I was referred to were keen to do surgery.

As a consequence I have been living with a SupraPubic Catheter (SPC) for the last 5 years. It is quite manageable and I am happy to provide further details if required.

[akaipop3ps in reply to Chask]

Chask, what was the reason that they gave you for not wanting to do the surgery?

Did you have Radiation treatment(s)?

[Chask in reply to akaipop3ps]

Yes I had radiation. There was conjecture about whether the retention was caused by the radiation or the surgery. Shortly after surgery I had a cystoscopy and the Uro remove a loose staple he found at the neck of the bladder! So there may have been some damage done there.

Ironically before the retention started I was almost continent and then suddenly became massively incontinent. No real explanation for that and it was following a series of cystoscopies that I gradually become more retentive to the point where I became totally blocked. There was some speculation that my urethral sphincter may have been damaged and was no longer functioning.

The specialist Uro (who was not my prostatectomy surgeon) just shook his head and said it was too complex. He actually suggested a full Urostomy but I didn’t fancy that so went back to my original Uro. While he didn’t specialize in urethroplasty, he offered to consider it but thought that an SPC connected to a flip flo valve would be a safer solution. There was also a risk that even a successful urethroplasty could return me to major incontinence. I certainly didn’t want that so opted for the SPC which I have been living with quite happily for the last 5 years.

[ppulatie]

Never had RT but had the stricture after having had numerous cystoscopies, having worn a catheter for 6 months, and then two surgeries, one to remove bladder stones and the second for stones and a small tumor on the bladder wall.

Feb 2019 was the second surgery. In April, developed the stricture. Total blockage. Doc did a urethea dilation and since then, I have been fine.

Good luck with whatever you decide.

[Hirsch]

Recommend u c l a department of urology. One of the world’s leading programs.

[Nigu-1]

Hi. I had Hifu in 2010, Focal Laser Ablation in 2014 & 2016. After each procedure I would get bladder neck strictures caused by scar tissue. My urologist reamed me out at least 7 times or more during that period. After my last FLA in 2016 I went to see a Natropath who gave me some tinctures to remove and prevent scar tissue. In 2017 I had proton beam radiation and was told that given my past history of bladder neck strictures I would probably again have to have scar tissue removed at some point. Well that was over 3 years ago and I have had no problem with scar tissue at the bladder neck since. In fact the tinctures I was given almost completely removed a large (one inch long) scar on my chest from surgery to remove a large cists. Not sure if this would work for everyone but it sure worked for me.

[akaipop3ps]

Thanks Nigu -

What exactly is the tincture and how did you use it? Was it injected?

Was it prescribed by the Naturophatic Physician?