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Hello all, I'm new to this forum and I'm trying to find people who have experience with the surgical procedure of an External Transurethral Sphincterotomy.

I've dealt with urinary incontinence for quite some time now, however something has changed. My bladder is no longer fully emptying like it has for the last several years. In fact it's filling to the point that I get a tremendously painful spasm and purge only a small amount of urine. I still lack the control (as when I get the spasm I immediately feel the amount urine collecting into my diaper) but the bladder just isn't emptying like usual. This has resulted in 2 UTI's for me in the last few months. My Urologist has run many tests trying to find the source of the problem. He said the sphincter isn't relaxing, and is remaining closed pinching off the urethra. Which causes my bladder to fill and ultimately to spasm and purge some of the pressure from the built up urine. After being prescribed multiple medications that have had no effect, he said that my best option is to use intermittent self-catheterization to empty my bladder completely. I've had many catheters inserted in my rather short lifetime, they are extremely painful for me. There's no way I could even remotely handle the pain and insert one on my own. I declined his suggestion.

I decided to search for surgical solutions. I found the Sphincterotomy. Which is essentially the procedure of using a Cystoscope (I've had a couple of those used on me already) to send a precision cutting laser in to sever the urethral sphincter. After reading and learning about the possible outcomes and complications, I felt pretty confident that this is what I'm looking for. The procedure would allow my bladder to contract and empty with it's own reflex, the sphincter being non-functional means there would be no resistance and the urine would flow free. It sounds like the solution to my issue.

When I met with my Urologist again I asked him about this procedure, he advised against it as it "Would be a Permanent Procedure, which would cause full urinary Incontinence and I wouldn't want that given my young age". He also stated it would require the constant use of a collection device like a "Condom Catheter, or a Diaper" I responded with "Where have you been the last 8 years? That's how long I've been coming to you because of my Incontinence issues. I've been wearing diapers for that amount of time. I've become accustomed to it. I would much rather continue my life comfortably in diapers, than to be having horrible pain from spasms and UTI's." Our appointment ended with him prescribing another medication (still no luck), and said we'd meet again in 30 days and go from there.

So I need to know, is this procedure what I'm looking for?
If anyone here has had it doneor know someone who has, please give me some details about how well it worked!

Thank's in Advance!

J93,
Have you ever tried a indwelling catheter, I have use them for awhile with good results. Im just not good with having them cut on me so that's what I have been using. Plus if he says its permanent you might give that a try first.

I believe b Brian has had this procedure done. The biggest thing I would worry about more than leaking is the inability to have kids cause of the retrograde ehavylation and also the incredible and clots that b Brian has experienced resulting from it...
I am definitely very weak on pain in those nether regions.

I had my external urinary sphincterotomy in August, 1999. In my case, it has caused continual leakage, and, when I drink too much in a short period of time, a fairly steady stream. If you can deal with the psychological issues that accompany permanent, and likely irreversible incontinence, and understand what you will need to do to manage, go for it, with my blessing.

Yeah, you've come to the right place all right. I've had SIX sphincterotomies in the past few years, and have at least one more to come.

I'll comment more on it when I get a chance later.

Ok, so just a couple of misconceptions, and a lot of information left out here too. I wasn't aware of at first either though & actually wonder if my urologist purposely left a lot of it out (maybe for good reason though so as not to scare me away from it).

1. A sphincterotomy does not completely remove your sphincter, in fact it only removes a thin layer of the muscle. For me, it took three surgeries to remove enough of a layer so my external sphincter would not be able to close all the way. The reason for this is that they can only cut into muscle so deep before it bleeds too much. Too deep and they could literally make you bleed out. Hence the reason why they don't go too deep.

2. There are several levels/methods for performing a sphincterotomy. The lightest is making a single deep cut at the 12 o'clock position. It has the least amount of bleeding & pain, but also is very ineffective at opening you up enough to relieve some pressure without sacrificing control. The second is three cuts at the 12, 3, & 6 o'clock positions. This tends to relieve pressure better while still not sacrificing too much control but will likely leave you leaking a little at times. The last is a full radial cut. It is the most effective at opening you up, but also has the most pain & bleeding associated with it while being better at allowing your bladder to actually empty.

3. Even after just any one of those sphincterotomies your muscle will still work as it did before. The only difference is the pressure it can hold back will be reduced (possibly by a lot depending on which surgery). It takes multiple surgeries to get it to where your bladder will actually not fill up anymore. And this assumes your internal sphincter will be open all of the time too (it won't be).

4. Your internal sphincter will still work as it did beforehand, and will tend to keep your bladder somewhat full. You do not have conscious control of this muscle either. If it isn't working right as well, then you may end up needing to have it operated on multiple times too. Otherwise, you'll probably still just have those urges and/or your bladder with fill up but with lesser amounts and/or lesser pain with each urge or overfill.

5. They very seldom ever use a laser. Most sphincterotomies are done using a hot knife. It heats up and burns through the tissue while partly cauterising it to reduce the bleeding. Laser systems are supposed to be more efficient, and leave less damage to the tissue you want to keep while focusing more on just the harder muscle. This can let the doctors cut deeper without causing more bleeding- but only if they use it. If the laser is even an option, inquire or push on getting it if you can.

6. You will bleed a LOT for about 5 days after the surgery. It's scary, but totally expected. If you have a decent amount of feeling in your urethra then it will also be painful as ever for about two months. Sitting isn't too much of a problem as long as you use a perennial donut and stay seated though. It's the getting up or down that gets you the most. Oddly though, walking nice and slow around a short block will actually help reduce the pain a little too.

7. You will have a catheter in for 3-7 days after the surgery. This help slow the bleeding and to help the tissue to heal open more. It is also needed to keep you'r urine flowing with no pressure on the urethra. I too am very sensitive towards catheters which tend to hurt a bit. That pain was drowned out by the surgery though and didn't seem to make it any worse at least. Also, Lidocane ointment (specifically not the gel they like to use), will also go a long way for pain or discomfort at the tip of your penis. When the catheter dries out, but put a little ointment on it prevent it from sticking. The gel on the other hand is water based and will dry out fast and sticky, the opposite what is need here.

8. As you heal, large blood clots will break loose and you will pee them out with just a little pressure behind it. It doesn't hurt, but is a startling feeling that also leaves you wondering how a clot that big was even passed at all. At least it isn't painful, but after passing a clot you will bleed more for up to a day.

9. The pain and bleeding will slowly taper off for about two months, then you will begin feeling normal again. You will not be fully healed after this time though and absolutely need to take it easy for at least two more months. Seriously, if you're two months out from the surgery, do not let your work fly you coach from Florida to Hawaii and back again a few days later. You will set yourself all the way back and go through all that pain & healing again.

10. And the most important of all. The surgery is absolutely worth going through all of this in spite of the hardships! Seriously, why else would I have gone through six of them (actually two were to remove internal cists that bulged into my urethra from my straining and closed me off- it's the same exact surgery though. so three for the external, two for bulges, and one for the internal, plus as least one more to come but finally with the laser). Really though, if anyone is even considering this surgery then they're in bad shape already and know this needs to be done. You've probably been slowly getting worse and worse the last year or two, right. Putting it off or thinking ignoring it will make things better will lead to it continuing to get even more worse still. I got to that point in spite of seeking out a urologist that would do this surgery for me. And I was at a point where my body was bleeding out and about to shut down and kill me. Yea this is scary as crap, but not going through it is worse.

11. Once you've gone through it all and healed for a couple of months you will be feeling SO much better. That being better is permanent, and it only cost a couple months of hardship. The trade off is more than worth it in my book, but it is a trade off none the less.

Brian,

Wow! That was one impressive explanation and evaluation of the sphincterotomy procedure. Thank you. I wish I had known that much before my surgery.

Thanks. I hated not knowing if something was supposed to be happening as expected, or not being able to mentally prepared and plan for what's to come.

I can understand telling patients all of this might scare them off from getting done what's needed, but not telling us just leaves us in the dark, ill prepared, and worrying if something is normal or gone wrong. Obviously I'd rather be informed and prepared than forced to stumble through the dark. At the very least we should be given that option by our doctors but it never happens and I believe that to be no better than being lied to.

Brian it is extremely terrifying procedure eek bleeding out from your dick..... ugh Makes me a bit quezy thinking about it. Did you have to get a blood transfusion after doing it so many times and bleeding so much?

Scary, but not terrifying. And no, I never came close to needing a transfusion. My total blood loss was probably less than if I had donated a pint of blood. My surgeries have all been about 6 months apart too, so my body had way more time than needed to replenish it. Still, I get what you're saying. One drop of blood out of there is too much under most any circumstances.