Since the blog was started. We've had our ups, downs, and a few slides sideways, but we've succeeded in disseminating information to those in need which was not previously available without doing tons of research. To all who have participated, many thanks, and we wish you the best of health.
Per: Moderators Cesar and Tim
Wednesday, November 28, 2012
Monday, November 19, 2012
An answer of a Question about Urethrotomy; from one of the very best, Dr. Joel Gelman, M.D.
After receiving commentary from one of his patients who remarked that he had garnered some information from our blog-site, we were contacted by Dr. Joel Gelman, M.D., of the Center for Reconstructive Urology. Anyone who has ever searched on the topic "urethral stricture" is well acquainted with his status as one of the WORLDS very best with regards to urethral reconstruction surgery. I am elated that he took time from his busy schedule to contact us.
Another factor which precipitated his contacting us was our reasoning behind the deletion of the commentary by blog reader MNOQOCUA.
His letter to us should serve to answer questions those who are newly diagnosed may have with regards to the most effective method(s) for addressing your situation.
I enthusiastically post this letter, with most sincere thanks!
Per: Moderator Tim
Moderator Tim,
Actually it is true that a urethrotomy usually makes the stricture worse. Observation is associated with certain risks (bladder damage, infection, renal damage etc.). Urethroplasty also can make a stricture worse when done by someone who is not exclusively specialized in male urethral surgery. A very high percentage of my patients come to me after failed surgery done by doctors at Major Universities who really do not truly have real expertise in male stricture surgery.
I believe what all viewers with strictures should do is make sure their stricture is definitively diagnosed (including imaging) prior to treatment, and that they should be informed of ALL options and the risks, benefits, and expected outcome of each option (with one option being observation) before pursuing treatment. This is what is required for informed consent. In the case of a 3+ cm stricture, the chance of a cure with a urethrotomy is pretty much zero. That does not mean a patient can not choose to be managed this way. However, if that patient is not made aware that an open repair, done by someone who is an expert at doing this surgery, offers a very high probability of a cure, then he is not giving informed consent for the urethrotomy.
I would be happy to be of any help to you with your Blog. I assume you have seen my website. I hope to update it soon as my goal is for it to be a very helpful informational site for men with urethral strictures. I am just so busy surgically, my time is limited. If you have any specific suggestions for my website, I would welcome the feedback.
Sincerely,
Joel Gelman, M.D
Director, Center for Reconstructive Urology
Department of Urology
University of California, Irvine Medical Center
http://www.centerforreconstructiveurology.org
Another factor which precipitated his contacting us was our reasoning behind the deletion of the commentary by blog reader MNOQOCUA.
His letter to us should serve to answer questions those who are newly diagnosed may have with regards to the most effective method(s) for addressing your situation.
I enthusiastically post this letter, with most sincere thanks!
Per: Moderator Tim
Moderator Tim,
Actually it is true that a urethrotomy usually makes the stricture worse. Observation is associated with certain risks (bladder damage, infection, renal damage etc.). Urethroplasty also can make a stricture worse when done by someone who is not exclusively specialized in male urethral surgery. A very high percentage of my patients come to me after failed surgery done by doctors at Major Universities who really do not truly have real expertise in male stricture surgery.
I believe what all viewers with strictures should do is make sure their stricture is definitively diagnosed (including imaging) prior to treatment, and that they should be informed of ALL options and the risks, benefits, and expected outcome of each option (with one option being observation) before pursuing treatment. This is what is required for informed consent. In the case of a 3+ cm stricture, the chance of a cure with a urethrotomy is pretty much zero. That does not mean a patient can not choose to be managed this way. However, if that patient is not made aware that an open repair, done by someone who is an expert at doing this surgery, offers a very high probability of a cure, then he is not giving informed consent for the urethrotomy.
I would be happy to be of any help to you with your Blog. I assume you have seen my website. I hope to update it soon as my goal is for it to be a very helpful informational site for men with urethral strictures. I am just so busy surgically, my time is limited. If you have any specific suggestions for my website, I would welcome the feedback.
Sincerely,
Joel Gelman, M.D
Director, Center for Reconstructive Urology
Department of Urology
University of California, Irvine Medical Center
http://www.centerforreconstructiveurology.org
Sunday, November 18, 2012
Sorry for not updating....
My apologies to everyone, as I have been in and out of the hospital (for a problem unrelated to urethral stricture disease) since mid-August, and have been unable to keep up with this site. I have loads of material to upload, however, finding the time to do it is a different story.
Please bear with me through this difficult time.
Per: Moderator Tim
Please bear with me through this difficult time.
Per: Moderator Tim
Sunday, August 12, 2012
Update for the week of 12 August 2012
My local pharmacist and friend, who last year co-authored two posts about antibiotics and antibacterials, has urged me to address antibiotic resistance. It is his understanding that UTI's are becoming increasingly tolerant to treatment, some to the point of having to either utilize multiple agents, or IV infusion (first dose in hospital, then in-home administration).
This week, he will again co-author an article in cooperation with "Dr. Rob", a podiatrist, and expert on the pathology of bacteria. He has authored several articles on the topic, some of which have been included in the Journal of Podiatry.
This will be useful information for all.
We are also considering linking with the Interstitial Cystitis Support Group, as some of our information, and theirs has the possibility of being mutually beneficial.
We're also working on uploading some items to the resources site.
Have a great week!! BTW: Last week, we had a visitor from Iran!, welcome!!
Per: Moderator Tim
This week, he will again co-author an article in cooperation with "Dr. Rob", a podiatrist, and expert on the pathology of bacteria. He has authored several articles on the topic, some of which have been included in the Journal of Podiatry.
This will be useful information for all.
We are also considering linking with the Interstitial Cystitis Support Group, as some of our information, and theirs has the possibility of being mutually beneficial.
We're also working on uploading some items to the resources site.
Have a great week!! BTW: Last week, we had a visitor from Iran!, welcome!!
Per: Moderator Tim
Friday, August 10, 2012
Contacting a Reconstructive Urologist in your area
We now have a (fairly) complete listing of Reconstructive Urologists in the United States, who list their sub-specialty as being "male reconstructive surgery". The list covers all 50 states and three territories. Should you want to know the names, addresses, and contact information for specialists in, or near your location, please email us at urethralstrictures[nospam] at yahoodotcom. We will do our very best to respond quickly and accurately to your request.
Our library also includes listings for specialists in urethral reconstruction, this list does NOT cover all 50 states; however, it does provide for regional information.
As before, a "board certified urologist" is not necessarily a specialist in urethral surgery, for the best outcome, we must endeavor to find the very best possible surgeon within our means.
Per: Moderator Tim
Our library also includes listings for specialists in urethral reconstruction, this list does NOT cover all 50 states; however, it does provide for regional information.
As before, a "board certified urologist" is not necessarily a specialist in urethral surgery, for the best outcome, we must endeavor to find the very best possible surgeon within our means.
Per: Moderator Tim
Thursday, August 9, 2012
The Ethical Decision to Delete Commentary, and the reasoning behind it...
Many of you have noticed 21 rather lengthy comments by reader "mnoqocua", most espousing the virtue of not seeking the surgical revision of urethral strictures. I left the commentary intact because it included multiple references to popular websites, and those publications were based on recognized medical and scientific principles. I also declined comment on those commentary postings which took place over a very short time period in March of this year.
For nearly six months I mistakenly thought that they provided some useful information, and were, for the most part harmless. Yesterday however, I received an email from a "novice" stricture patient who read "mnoqocua's" comments, and was considering the option of not returning to his urologist for a recommended followup urethrotomy, which the urologist believes to be necessary because of an estimated 3mm diameter x 3.4cm obstructive stricture.
To have followed the advice proposed by "mnoqocua" could have been disastrous in this case, it is for that reason that I have chosen to delete his comments in their entirety, all 21 of them.
As stated in the introduction to this site, we do not provide medical advice, we are not physicians; although we have two physicians who advise us on content, our goal is to provide information as to the options available to those suffering urethral stricture disease, PERIOD, OPTIONS - THAT'S ALL!!
I could have chosen to remove a majority of them earlier, but decided to leave them intact because I am a firm believer in allowing the opinions of all to be heard unless they are totally irrational and without reason, and these were not.
"Mnoqocua" appears to have had an axe to grind with regards to "invasive interventive urethral surgery options" because of what appears to be an alleged misjudgement of, or alleged mishandling of his situation by a urologist who was perhaps unfamiliar with urethral strictures and their management. As before, "Board Certified Urologist" does not necessarily mean that the physician is an expert in urethral surgery, or for that matter evaluation and management of strictures both complex and of lesser severity in nature.
To have advocated that persons with urethral stricture disease "leave it alone" would be dangerous; espousing that viewpoint could in-fact be disasterous for obvious reasoning. This person even contradicted my reasoning for a humorous post referencing the Fox Network's "King of the Hill", and the principal character's (Hank Hill) "Narrow Urethra".
All posts which include personal viewpoints are referred to an attorney for legal "exposure" analysis, and to a physician, for evaluation of their efficacy and basis in fact. We have that obligation to our readers, and to the urologists and publications who refer their patients and clients to this site.
As always, PLEASE continue to email your questions, and should you feel the need to offer constructive criticism, opinion, or verifiable information, please post them. If deemed to be informative, and worthy of inclusion, they will become part of this site's informative database.
From this point forward, all comments will be moderated, PERIOD. This goes against every grain of my being, however, it is sadly necessary. My apologies, and please continue to post commentary and send email with your questions....
Per: Moderator Tim
For nearly six months I mistakenly thought that they provided some useful information, and were, for the most part harmless. Yesterday however, I received an email from a "novice" stricture patient who read "mnoqocua's" comments, and was considering the option of not returning to his urologist for a recommended followup urethrotomy, which the urologist believes to be necessary because of an estimated 3mm diameter x 3.4cm obstructive stricture.
To have followed the advice proposed by "mnoqocua" could have been disastrous in this case, it is for that reason that I have chosen to delete his comments in their entirety, all 21 of them.
As stated in the introduction to this site, we do not provide medical advice, we are not physicians; although we have two physicians who advise us on content, our goal is to provide information as to the options available to those suffering urethral stricture disease, PERIOD, OPTIONS - THAT'S ALL!!
I could have chosen to remove a majority of them earlier, but decided to leave them intact because I am a firm believer in allowing the opinions of all to be heard unless they are totally irrational and without reason, and these were not.
"Mnoqocua" appears to have had an axe to grind with regards to "invasive interventive urethral surgery options" because of what appears to be an alleged misjudgement of, or alleged mishandling of his situation by a urologist who was perhaps unfamiliar with urethral strictures and their management. As before, "Board Certified Urologist" does not necessarily mean that the physician is an expert in urethral surgery, or for that matter evaluation and management of strictures both complex and of lesser severity in nature.
To have advocated that persons with urethral stricture disease "leave it alone" would be dangerous; espousing that viewpoint could in-fact be disasterous for obvious reasoning. This person even contradicted my reasoning for a humorous post referencing the Fox Network's "King of the Hill", and the principal character's (Hank Hill) "Narrow Urethra".
All posts which include personal viewpoints are referred to an attorney for legal "exposure" analysis, and to a physician, for evaluation of their efficacy and basis in fact. We have that obligation to our readers, and to the urologists and publications who refer their patients and clients to this site.
As always, PLEASE continue to email your questions, and should you feel the need to offer constructive criticism, opinion, or verifiable information, please post them. If deemed to be informative, and worthy of inclusion, they will become part of this site's informative database.
From this point forward, all comments will be moderated, PERIOD. This goes against every grain of my being, however, it is sadly necessary. My apologies, and please continue to post commentary and send email with your questions....
Per: Moderator Tim
Sunday, August 5, 2012
Frontiers in Reconstructive Urology, EUROPE : Dr. Enzo Palminteri, Arezzo, Italy
A long, long time ago, before the days of Google®, when the premiere search engines were Yahoo®, Lycos®, and the Northern Light® search engine, when you would enter the words "urethral" + "stricture" into the subject field, the name "Enzo Palminteri, M.D. would appear, followed by oodles and oodles of publications authored by him. In 1998, we had a rather lengthy three-part correspondence regarding "difficulties" that I had encountered with a permanent urethral stent; which were (then) new to the United States, but had been implanted in Europe and other countries for several years previously.
I will say that his evaluation and opinions were quite accurate.
There is an association of the world's reconstructive urologists which travels to "out of the way locales" in order to demonstrate their invaluable techniques to local urological surgeons, Dr. Palminteri participates in this association, as do the other surgeons listed within the "Frontier's in Reconstructive Urology" series.
If we ever decide to "monetize" this site, the pittance which we receive will be directly donated to assist these surgeons with their travel costs; I have been told that most of those are out of pocket.
Many of Dr. Palminteri's urethroplastic techniques were vast improvements over those traditionally performed at the time. He was among the first to warn of the problems with "permanent urethral stents", and has among the most highly skilled hands of those which perform the Johansen's procedure.
I can go on and on, referencing his publications, and his work. There will be references to his publications and his videos on our "resources" site. For now, here's a link to a Youtube® video of his performance of a urethroplasty using a buccal mucosal autograft: http://www.youtube.com/watch?v=UsbiHmxM6zs&noredirect=1
Per: Moderator Tim
I will say that his evaluation and opinions were quite accurate.
There is an association of the world's reconstructive urologists which travels to "out of the way locales" in order to demonstrate their invaluable techniques to local urological surgeons, Dr. Palminteri participates in this association, as do the other surgeons listed within the "Frontier's in Reconstructive Urology" series.
If we ever decide to "monetize" this site, the pittance which we receive will be directly donated to assist these surgeons with their travel costs; I have been told that most of those are out of pocket.
Many of Dr. Palminteri's urethroplastic techniques were vast improvements over those traditionally performed at the time. He was among the first to warn of the problems with "permanent urethral stents", and has among the most highly skilled hands of those which perform the Johansen's procedure.
I can go on and on, referencing his publications, and his work. There will be references to his publications and his videos on our "resources" site. For now, here's a link to a Youtube® video of his performance of a urethroplasty using a buccal mucosal autograft: http://www.youtube.com/watch?v=UsbiHmxM6zs&noredirect=1
Per: Moderator Tim
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