|
Thanks ILuvLA. And thanks Patrick, sometimes I need to be reminded of that.
I had the cystoscopy Monday. They brought in a scope from pediatrics to do it. The cystoscopy went fairly well, not any more painful than dilating (less, in fact), and the urologist got a very clear view of the stricture. It is exactly where I suspected it to be; dilating has made its location evident. The problem spot is right at the base of my penis, where it joins the scrotum. Looking back through the OR photos, urethral tissue and several sections of skin were brought together and stitched at this junction. It is unsurprising that I have a buildup of scar tissue in this area.
I had dilated through a size 12Fr and 14Fr (largest I can do) the night before, otherwise I think the cystoscopy would not have gone as well. The urologist put the scope up to the stricture point and no further. On screen, the narrowing was very evident. It looked like a wall of flesh with a tiny dark hole in the center. Trying to fit the scope (which was rigid and oblong in cross section with a blunt tip, not flexible and rounded like I expected) through that opening--my urologist didn't even want to try. He reported that the urethral mucosa looked healthy and I haven't been damaging myself with the dilation, then pulled the scope out and we talked surgery options.
The surgeon seemed pleased that the stricture is not as far in as he expected (and was told to expect by my original surgeon). For a metoidioplasty with urethra lengthening the most common point for a stricture is at the point of anastomosis, or the 'join' point between native and neo-urethra. If I am correct in my anatomy knowledge, this location is very close to the external sphincter. That, I believe, would complicate matters.
One thing in the back of my mind: he was not able to put the scope that far into the urethra to look, so he was partially going by my report of only needing to dilate the first couple inches of urethra to get relief from the stricture. It does not feel as though there is another stricture further back, but I could be wrong. There is a possibility that I will get this first stricture repaired only to find that there is indeed a second further back.
Actually, I should say third. The first stricture is actually right at the urethral opening at the tip of my penis. That is another location where suture came together. The surgical repair being proposed would not address this 'tip' stricture and I would still need to dilate it. To try to fix both strictures with a full length graft would mean literally disassembling my penis, something this surgeon admitted he has never done--he fixes strictures, he doesn't perform metoidioplasties. That is my original surgeon's specialty. I do appreciate his frankness and humility in this regard.
So what he would be doing is opening the base of my penis (leaving the upper portion intact) and scrotum midline, possibly as far back as the perineum, cutting out the scar tissue, taking a 2.5cm buccal mucosa graft from inside my cheek, laying it over the defect, then closing everything up and hoping for the best. This should fix the current stricture, but it is possible that I could form 2 new strictures, one at either end of the graft. It really just depends on how my body heals; it is impossible to tell right now. Either I end up better off or worse off. Roll the dice.
He couldn't give an exact time I would have to be out of work. Past experience says sitting upright in a firm office chair for hours would be difficult, even with a 'donut.' I would have a Foley in for the first 10 days or so, then a suprapubic for another 10 days to give the area more time to heal. For this time period, I would expect to be either partially reclined on a soft surface or slowly shuffling around--like the last time I had this done. But unlike the last time, I will not have new testicular implants trying to heal, so things should be easier. I hope.
Tentatively, surgery would be this fall when life is less busy. In the meantime, I need to call the hospital financial department to try to nail down how much this is going to cost. Just bought a house, not really feeling getting slammed with unanticipated medical bills right now. And as the surgeon pointed out, though he will code everything as a standard stricture repair, if my insurance does some digging and uncovers my medical history, coverage will most likely be denied as a 'complication following an elective procedure.' My non-covered 'elective' medical bills ring in at $30,000+ out of pocket so far; the potential for adding several thousand more is unwelcome to say the least.
Fun stuff, and I've yet to hit 30. With the medical expenses I've racked up so far in life, remaining employed is imperative. This is why I place such a high importance on work--my continued health management actually depends on a decent income, along with the health coverage that I live in fear of losing.
Anyways, another wall of text from me. If you've made it this far, thanks for listening. I realize most of what I post has very little to do with incontinence, the subject of this board. My leaking and poor bladder control are almost a sideline to what I consider at this point to be the 'main problem': the strictures, pain, and infections. Writing all this out just helps me sort my own thoughts sometimes, so in the moment I probably make a bigger deal of everything than it really should be.
|
Login
Register
FAQ
Search
