Urethral stricture?
April 8, 2016 | 15,00 EUR | answered by Dr. David Meyer
Hello,
I hope someone here can possibly reassure me.
I am a 34-year-old female.
About 6 weeks ago, I had a laparoscopy where my appendix was removed. A bladder catheter was also inserted during the procedure. I also had a drainage tube for 4 days as the peritoneum was inflamed and fluid needed to drain. Since then, I have had varying degrees of problems with my bladder and urethra. Urinating was painful or stung during and after. Urine was tested in the hospital and shortly after, and no bacteria or similar was found.
About 3 weeks ago, the symptoms worsened, so I saw a urologist. They diagnosed a bacterial infection. I then took Monuril, followed by 10 days of Canephron. The symptoms improved.
However, as it is still not back to how it was before the surgery, or I still have mild symptoms, my urologist conducted a urine flow test. Unfortunately, the results were not great:
The values are as follows:
- max. flow 24.5 ml/s
- average flow: 8.3 ml/s
- micturition volume: 232 ml
- flow time: 28 s
- micturition time: 38.5 s
- time to max. flow: 12.9 s
- acceleration: 1.9 ml/s+s
- delay: --- s
I must mention that I was tense during the test. I am always nervous at doctor's appointments, and when I am nervous, sometimes it is harder for me to empty my bladder because I focus on it.
I am now a bit puzzled because the doctor said it indicates a narrowing of the urethra.
Fortunately, the bacteria have disappeared, I have no or hardly any residual urine in the bladder, and nothing else abnormal in the ultrasound.
Could it still be that the catheter, which was only in the urethra for 2 hours, caused a narrowing?
By the way, I do not have the impression that the stream is different from before.
I would be very grateful for any information, as I am now really panicking that I may have to undergo surgery soon to have the urethra slit. I really do not want to have to do that.
Thank you in advance.
Dear questioner,
The insertion of a bladder catheter and drainage during an appendectomy is completely normal. Especially in women, it is never completely avoidable, even under the best circumstances, that bacteria are carried in during the sterile insertion of a bladder catheter, resulting in a urinary tract infection. The foreign body in the urethra and bladder also causes irritation and promotes bacterial colonization. Urinary tract infection is the most common nosocomial infection in hospitals, meaning the most common side effect of a hospital stay.
If the patient then experiences symptoms and a urine culture is performed, often no pathogens can be found, or the mixed flora or urethral flora cannot be distinguished from the pathogens causing the symptoms. In your case, no pathological bacteria were found in the urine, which is not surprising after a short catheterization in an otherwise healthy woman.
It is also true that catheterization can cause reactive swelling of the urethra in addition to irritation, and the foreign body irritation in the bladder can cause symptoms of a urinary tract infection (burning during urination, frequent urination, pain).
The fact that your symptoms still persist after 3 weeks is unusual. Your urologist performed a urine sediment test and a uroflow test. The sediment showed that bacteria were present in the urine, which is not immediately concerning but should be monitored/treated. If bacteriuria persists and you continue to have symptoms, further investigation should be conducted, as your urologist did. He is checking if bladder emptying is not functioning properly.
Based on the uroflow results of 24.5/9.3/232, I do not see any poor results, even if you were tense. I assume there was no residual urine. The treatment with Monuril and Canephron is guideline-compliant and has successfully eliminated the bacteria in your case.
It is possible to experience temporary swelling of the urethra and a "disruption" of the sphincter muscle due to catheterization, but I am not aware of any cases where these symptoms lasted more than a week.
You do not need to fear permanent scarring that could require surgery. Urethral stricture develops over a longer period.
I recommend waiting and using anti-inflammatory medications like Diclofenac (Voltaren) or Ibuprofen to help reduce obstructive urinary symptoms. This is a common practice in urology after catheter removal and inadequate flow results.
If you continue to have symptoms, I recommend seeing the urologist again and performing another urine sediment/culture or initiating a calculated antibiotic therapy with a well-tolerated broad-spectrum antibiotic like Cefpodoxime for 7 days, in combination with Diclofenac 25mg twice daily. The latter is available over-the-counter at pharmacies.
Overall, it is expected that your symptoms will improve on their own.
Best regards and get well soon,
Dr. Meyer
(Urologist)
