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Date of last update: 8/13/2017.

Forum Name: Urology Topics

Question: Ankylosing Spondylits and urethroplasty to repair stricture.

 ASo - Tue Dec 23, 2008 5:02 am

Hi. Apologies in advance for the length of this post.

I am a man currently awaiting a urethroplasty operation to repair a recurrent urethral stricture near the s-bend in front of the prostate and have some questions I would like to get a second opinion on.

I am very lucky to have an excellent urologist who has a great deal of experience but I have severe Ankylosing Spondylitis (an auto-immune form of arthritis) and am very concerned about not only how the urethroplasty operation itself will go but also about how my A.S. is going to react post-surgery paticularly in relation to the two catheters I will have post surgery.

In 2007 I had a urethrotomy to try repair the stricture which was only found due to my going into Acute Urinary Retention due to constipation caused by pain medications. The surgery was successful for a time. The post-surgical period was horrendous though. My A.S. was flaring out of control and due to the catheter my penis swelled quite severely and my urethra seemed to attack the catheter with huge amounts of pus which turned out not to be an infection but had plenty of inflammation cells in it (it was sent off for tests) and my penis head swelled by about 15-20% at a guess and it caused a hypospadia.

The stricture returned, however, and now I am waiting for surgery again and I am very worried about this happening again after my urethroplasty. I am having to come off my strongest immune suppressant pre-surgery because of the risk of infection and am very concerned that this will make the situation worse as I have been told I will come out of surgery with two catheters (suprapubic and urethral) and they both will be in for a minimum of two weeks. I just know my body will attack the urethral catheter again.

Is there anything I can do or ask the urologist to do to minimise this kind of reaction? The surgery is going to be unpleasant enough without having to deal with this kind of reaction. Am I correct in my thoughts that the inflammation cells in the pus were a result of my immune system attacking the catheter?

If you read all this then thank you for patience. Any responses gratefully received.
 Dr.M.Aroon kamath - Mon Oct 19, 2009 7:43 pm

User avatar Hi,
You have been already diagnosed as having Ankylosing Spondylitis.The moment you mention urethritis, the next thing that comes into one's mind (rightly or wrongly!) is Reiter's syndrome.
Reiter's sndrome is thought to be autoimmune reaction of the body to an underlying infection---- presenting as uveitis(and conjunctivitis),urethritis and arthritis.

This process has not been reported to 'attack' a urinary catheter.
It is easier to imagine a foley's catheter...causing infection.....precipitating a Reiter's syndrome.
At the time of your first urethroplasty, you had not mentioned any flare-up of your arthritis or presence of uveitis. Therefore Reiter's syndrome becomes less probable (although it could have been atypical).
In all probability, the catheter associated urethritis was a local problem (? caused by a an inadequate peri-catheter space).
Hope your second procedure will go ahed smoothly. Good luck!

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