Penile/urethra irritation post-prostatectomy.

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I had a robotic laparoscopic prostatectomy late Oct 23. I had significant incontinence post catheter removal even with pelvic floor exercises and a guided exercise program (and 1 coffee, no alcohol, no cola and carbonated drinks!). At week 8 my urologist prescribed Betmiga 25mg (mirabegron) as he felt my lack of progress was due to an overactive bladder. It has had a significant effect as at week 18 I'm down to leaking less than 10mL per day.

However, from waking post-surgery I had significant irritation in the penile head/urethra-a muted sharp feeling. I believe it was due to urine leaking around the catheter. I was given Ural but it didn't really help.

I have had the irritation since and thought it was due to urine leakage, but as I'm now nearly continent I'm not sure. It is relieved when I urinate...no pain but, returns later.

It appears to be worse with more concentrated urine so I tried drinking more water, but that did not appear to help. I tried 5 days of 4xUral doses (ie every 6 hours), but this did not help.

It appears to be relieved for a few minutes after pelvic floor exercises, but soon returns. This suggests that it is urine irritation. It is unlikely to be a bladder infection.

The irritation is strong at times especially at night keeping me awake. Taking paracetamol appears to ease the irritation.

My next urologist visit is in 2 weeks.

Has anyone else had this irritation? And solved it?

 

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YES!
I have that issue especially a UTI or something as you have said, I'm now scripted long term Nystatin cream after every cleaning and change so my orders were 3 times per day.
Lynn

 

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Hi - I am 30 months post-radical prostatectomy (robotic.). No leakage post-surgery. I did a lot of Kegels in the weeks leading up to the surgery which may have helped.

I experienced what you describe - an irritation/discomfort sometimes crossing the threshold to actual pain in the bladder, urethra and sometimes penis itself.

I did pelvic floor PT after about a year, which did help somewhat but I'm sorry to say it has not gone away completely. I feel like whatever nerve involvement happened with the severing and reattaching of the urethra may have caused this.

I got a urinalysis after about a year just to eliminate that possibility. It was negative.

I definitely feel it more with concentrated urine. After my middle-of-the-night piss it keeps me awake for an hour sometimes. During the day I drink a lot of green tea and don't notice it much if at all.

I also have bad acid reflux and short Barrett's Esophagus so I am on a low acid diet. No carbonated anything.

I hope it continues to ease, and I truly "feel your pain." I'm curious to see if more members weigh in on this subject.

 

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I had RP 28 months ago. After the catheter was removed, I had a narrowing at the opening of the penis. I am wondering if you have a narrowing somewhere in that area of the urethra? In my case, the Urologist did a meatotomy, basically a procedure to make the opening you pee through bigger, and that took care of the problem. It does create an issue with how wide the spray is, but eventually it got better and I got better at managing it.

I don't know if that has anything to do with your situation, but thought I would pass it along if you think it might be helpful and want to run it by your Doc.

 

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@Skirk I think you should see your urologist on emergency, immediately. It sounds like it could be a UTI, which can kill you before the end of the next two weeks if you don’t have medication to treat it. I don’t think you have two weeks to wait to see your physician.

Ural is kind of a joke; it doesn’t help anyone and isn’t even a prescription. It’s just a powder of vitamins, basically. That shouldn’t harm you but it’s certainly not going to help you with this problem you’re experiencing.

There is nothing wrong with taking as much Paracetamol (what we in the U.S. call Acetaminophen/Tylenol) as often as the box says you’re allowed to, though if you take it for very long, like for months on end at the maximum strength dose, you can get a stomach ulcer (which will be temporary and can be corrected quickly with another medication). Have you tried any anti-inflammatory medications, which here we call NSAIDs (non-steroidal anti-inflammatory drugs)? Here they go by the names Advil/Ibuprofen or Aleve/Naproxen. We can get them ourselves without the help of a pharmacist “over-the-counter”, but I’m not sure you’ll be able to. They’re similar to Tylenol but Tylenol is a pain reliever and Aleve and Advil are a pain reliever that works via anti-inflammatory.

Because the stars are so tiny, I’m not sure if your flag is New Zealand, or Australia (I think Australia, right), but in New Zealand and Australia, Aleve/Naproxen is called by the following names: Naprogesic, Sonaflam, Naprosyn, and Noflam. I used to be married to a Kiwi and learned those names when I briefly lived in NZ.

In NZ and AUS, our Advil may be called Ibugesic, I-Profen, Nurofen, Brufen, or Advil itself. There is an anti-inflammatory cream we both have called Diclofenac/Voltaren. You could try rubbing that on your penile head and urethral opening to see if it can deliver direct anti-inflammatory pain relief to tide you over until you next see your urologist in two weeks.

Unfortunately, most Urologists don’t have the answers we really need. The bladder is a very sensitive and complicated organ, as are all the parts connected to it, including the prostate. I’ve been on this forum for about seven years now, and I can’t believe the horror stories I’ve heard from men who’ve had a prostatectomy. It seems like no surgeon ever tells the truth about the after-surgery side effects, pain, and dysfunction before giving you a surgery because otherwise, you’d probably never have the surgery and they wouldn’t get paid!

Good luck!






@bobtabla @GaDawg Did either of you try these pain relievers and if you did, did they help?

 

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In my case, the pain was not that bad. It was more an ability to be able to void, which at the time I was told may be a reason for my incontinence. As it turned out, it did not really make a difference for incontinence, but I was able to void much better.

On Voltarin, which is the common brand name for Diclofenac cream: I am very familiar with this product as I am a pickleball player with a long history of arthritic knees. One of my knees has been replaced. I also have had rotator cuff surgery on both shoulders. Voltarin works well with joint pain, but a side effect is that it can cause skin irritation, especially if it hits the sun. I actually wear a disposable surgical glove when I apply it as my hands would get red, like a sunburn, and start peeling. That was worse using a generic, so I always use the Voltarin name brand. The manufacturer actually says that it should only be used on joints. While my penis does not have an issue with being exposed to the sun, I would not want Voltarin anywhere near my genitals.

 

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@GaDawg I’d try the Voltaren on my privates if I was desperate. You can always wash it off immediately and if you get a rection, take a Benadryl, no big deal.