Post-Da Vinci Surgery Complications: Urethral Stricture and Treatment Options - Urology

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Urethral stricture is a common complication that can occur after surgeries such as the Da Vinci procedure, particularly in prostate surgeries. This condition involves the narrowing of the urethra, which can lead to difficulties in urination, including symptoms like urinary retention, dribbling, and discomfort. Your father's experience with urethral stricture following his Da Vinci surgery is not uncommon, and it’s understandable that you are concerned about his treatment options and potential outcomes.

When it comes to the treatment of urethral stricture, there are several approaches. The use of a dilator or urethral sounds is a common initial treatment, as it can help to widen the narrowed segment of the urethra. However, as you mentioned, this method can sometimes lead to complications, such as nerve damage, which can affect bladder control and lead to discomfort during prolonged sitting.
In cases where dilation is not effective or causes significant complications, endoscopic surgery is often recommended. This procedure involves using a camera and specialized instruments to directly visualize and treat the stricture. The surgeon can remove the scar tissue causing the stricture or perform a urethrotomy, which involves incising the stricture to allow for better urine flow.
Regarding your concerns about nerve damage and the potential for urinary incontinence after endoscopic surgery, it is essential to discuss these risks with the surgeon. While endoscopic procedures are generally less invasive and have a lower risk of complications compared to open surgeries, there is still a possibility of affecting surrounding structures, including nerves. However, skilled surgeons take great care to minimize these risks.

As for the likelihood of needing further dilation after endoscopic surgery, it is indeed possible. Urethral strictures can recur, and some patients may require multiple interventions over time. The recurrence rate can vary based on several factors, including the length and location of the stricture, the underlying cause, and the patient's overall health.
In terms of the effectiveness of endoscopic surgery, many patients experience significant improvement in their symptoms following the procedure. However, the success rates can vary, and some patients may still experience issues post-surgery. It is crucial to have realistic expectations and to maintain open communication with the healthcare team regarding any ongoing symptoms or concerns.

In summary, your father's situation is complex, and while endoscopic surgery may provide relief from the stricture, there are risks involved, including potential nerve damage and the possibility of recurrence. It is vital to weigh these factors carefully and to have a thorough discussion with the surgeon about the best course of action. Additionally, follow-up care and monitoring will be essential to ensure the best possible outcome and to address any complications that may arise.