Bladder neck obstruction

Thanks for the info.

Brian, a bit slow at first then the penny dropped.

I do a fair bit of driving and post op started looking for toilets on journeys, I noted a lack of WCs , then I saw a sealable urine bottle in Boots so bought a couple. Keep one in the car just in case, not had to use it yet but it has measure scale on it,which was useful when doing the intake output for incontinence nurse and saves problems with the Yorkshire puds.

Read a bit about dilation treatment and get a bit concerned when it talks about attending A&E unable to pass urine.

I think I would like too plan what treatment and when rather than get what is given. Slow flow apparently is common 3-6 months post op and I am at 3 months post op. Brian I guess if your flow has been slow for a long time the opening has settled at an acceptable size.

I do have a slight kidney problem so not keen to store urine for too long.

Has anyone else had experience of other treatments for bladder neck scar tissue following RP.

Thanks Chris

Looks like I will have to answer my own question, flow rate was getting worse, frequency went up, when I say flow it was dribble and squirts. Got a call this morning can you come in Monday morning quick pr_ op then surgery in the after noon! not keen but Thursday morning thought it might be visit to A&E. Frequency every hour but only 100 mm or so (puds will have to taste strange a bit longer). Hope I am okay for Thursday or that will be another bi monthly support group meeting missed. Oh and possibly another UTI also on antibiotics again, GP say UTI should be gone for Monday.

First question Monday is it electric current.

Will let you know how it goes.

Thanks Chris

Now that's torn it just wet myself giggling, thanks for that Bri.http://community.prostatecanceruk.org/editors/tiny_mce/plugins/emoticons/img/smiley-embarassed.gifhttp://community.prostatecanceruk.org/editors/tiny_mce/plugins/emoticons/img/smiley-embarassed.gif

BFN

Julie X

Had the the bladder neck stretched Monday lunch time, they got the camera into the bladder had a look round and found a plastic object in the bladder, that may explain the water infections. I was supposed to have a tap on the catheter after the night bag but because it was not written up I had to have a bag. Had to stop over night because there was a lot of blood in the urine. Went back to work today a bit sore and was by passing quite a bit, then total blockage for an hour all back to normal now. Big debate about who by and when the catheter was coming out but now booked for Sunday. Next step lets see what it has done to the continence, surgeon was confident it would not affect it.

Thanks Chris

Bri

Lyn / Bri

Sorry for the delay in replying. Not had Lego in the house for a number of years, we did go to Monte Carlo but lost all the chips, that left the plastic urine jug, then I realised we had Yorkshire puds so it was back in the cupboard.

Brian was close with the staples, I think.

It was a bit hectic when the surgeon told me what had happened, but three things I remembered were clip, haemorrhage and migration. It is my assumption it was plastic from seeing video clips of the op. I am unable to contact my surgeon at the moment, but may get some info Sunday when the catheter is removed.

My first instinct was that the clip had been left in by accident, but Bri’s comment got the grey matter working.

I have delved into google and found that a “Hem o lok clip” is frequently used in robot-assisted laparoscopic radical prostatectomy, what I cannot find is confirmation that they are routinely left inside or that they are used in the UK, or how big the clips are if used in the procedure.

On another site, which I cannot now find, it described typical symptoms of clip migration, frequent UTI, urine retention and at three months poor flow rate, which pretty much describes what I went through.

The following are links to old US National Library of Medicine National Institutes of Health, 

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3272559/

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2963780/

Extracts from of the links below

Of the 641 patients, 25 (5.7%), 1 (2.0%), and 2 (1.3%) had a bladder neck contracture after RRP, LRP, and RALP, respectively. Two RRP patients had a bladder stone. In total, 6 patients had surgical clip-related complications. Metal clip migration was associated with 2 (8%) of the 25 RRP cases of bladder neck contracture and both (100%) of the RRP cases of bladder stone. Moreover, both (100%) of the RALP cases of bladder neck contractures were associated with Hem-o-lok clip migration into the anastomotic site.

It appears that surgical clips are prone to migration and may cause, or significantly contribute to, BNC or the formation of bladder stones after radical prostatectomy. These findings raise questions regarding the use of foreign bodies in close proximity to the vesicourethral anastomosis during radical prostatectomy. At the very least, they indicate that care must be taken with the surgical clips used for inducing hemostasis near the apex of the prostate in radical prostatectomy. In addition, because the incidence of BNC after RALP is low, when unexplained voiding difficulty occurs after RALP, one should suspect that a Hem-o-lok clip has migrated, especially because Hem-o-lok clips cannot be detected on X-rays.

Thanks Chris

Bri

Had the catheter removed Sunday morning, came out mid afternoon, bladder almost empty just a few ml left. Was passing urine every half hour until about 2200, got up at 0030, then 0230, and then 0400 for work. Frequencey slowed to every 2 hours during the day but not a lot of volume, 125 ml. rough flow rate 8-12 ml/sec so vast improvement there. Solid stream then stop, but get the feeling I want to pass more. I had a couple of close calls but continence is still there. Early days so will see how it goes tomorrow, in the office all day. Nurses did not have any info on clips, so still in the dark over that one.

Thanks Chris

Bri

Had normal catheter in from Monday to Sunday then removed. No self cathetering  and frequency getting further apart.

Got to say the bag and catheter was a lot easier this time after a simple procedure rather than after the original op. 

Thanks Chris

Bit of a bummer Chris. I did read that some men needed the procedure again but not that quick. Hopefully as he says something to do with the catheter removal.
My flow is the same fortunately. There is someone else on here burtcan't remember who, who has had a decreased flow for years.

I'm having an ultra sound scan of my kidneys etc as in a Q&A session with another consultant he confirmed there is the potential for kidney damage with a reduced flow. Quite angry that my consultant didn't arrange this

Hope your next op is successful

Bri