Patient: 12 years ago, I had urinary retention after having a child and was catheterized. Later, when I got angry, I had painful urination, and after checking the urine routine, it was normal every time, so I took antibiotics on my own to solve it with some relief. Now the flora is imbalanced. In July this year, I went to the First People’s Hospital in Yangquan, Shanxi Province, and was diagnosed with urethral stricture by urodynamics and cystoscopy. I have already done 5 dilatations to the 33rd and feel that the symptoms are reduced. I would like to know if there is any other good way besides dilatation? Or oral medicine, I want to cure it at once. Doctor: We have an innovative urethral closure area reduction procedure, which seems to be working satisfactorily so far, and have operated on nearly 200 cases, with patients coming from all over the country for treatment. Doctor: Your disease is not urethral stricture, because it is able to dilate to 33F. It is bladder outlet obstruction or urethral obstruction, which requires a special surgery. Patient: Dr. Zhang, my ultrasound sheet shows that the right renal collecting system is separated by 1.3 cm, and the bladder is 10.1*5.8*5.7 cm before urination and 6.8*2.9*2.8 cm after urination. Right hydronephrosis with residual urine in the bladder. Cystoscopy showed rounded and smooth bladder neck, elevated posterior lip, flat triangle, good bilateral ureteral orifice spouting, no occupying and ulcerative lesions in the whole bladder wall, and narrowed external urethra. Diagnosis and management opinion; bladder outlet obstruction, urethral dilatation was recommended. Urodynamics showed normal bladder sensation during the filling phase, good compliance, no unstable contractions, and normal manometric volume. During the voiding phase the forceps reflex was present, the maximum forceps pressure was 170 cmH2O, the maximum free urine flow was 13 ML/S, the residual urine volume after free voiding was about 100 ML, the flow rate with tube was 5 ML/s,diagnosis;bladder outlet obstruction. I did 5 dilatations to 33F , starting from 27. Once a week. Almost every time there is a small amount of bleeding, after the dilation urine pain for a day, after drinking less water to urinate will also hurt, must drink more water to urinate more to not hurt, to see a doctor is also so on fire pain. I would like to ask you to give me a detailed reply after reading my medical history, and if necessary I will go to see you for an interview. Thank you for your hard work. Doctor: From your urodynamic examination, the bladder maximum forced urinary muscle pressure of 170cmH2O and the urinary flow rate of only 13ml/s, i.e. high pressure and low discharge, you can diagnose bladder outlet obstruction; and the history has urinary retention with a residual urine volume of 100ml, which is already very serious. If the dilated urethra 33F probe can be dilated to enter, there is no external urethral stricture. It can be treated according to our new procedure. Patient: Thank you, Dr. Zhang, for your busy reply and first of all, I wish you a happy mid-autumn festival. I would like to ask what is the new procedure? Do I still need to dilate after the surgery? Is there any recurrence? What is the cure rate? How long do I have to stay in the hospital? Do I still need to dilate now? I am too far from Chongqing to consult with you for an interview. Patient: I also want to know if the surgery is painful? How long do I have to keep the catheter? Patient: Is bladder outlet obstruction and bladder neck obstruction the same thing? Our hospital says that bladder outlet obstruction is urethral stricture, are they right? Could Dr. Zhang please help me to explain. If the surgery works well, I would like to try it. Doctor: Bladder neck obstruction was a diagnosis made in the past when the pathogenesis was unclear and only the posterior lip of the bladder neck was observed to be elevated. Now we find that not only the bladder neck but also the entire functional urethra has elevated pressure, so the diagnosis is bladder outlet obstruction or urethral obstruction, but a 9mm diameter uterine probe can be dilated to enter and cannot be diagnosed as urethral stricture. The previous electrodesection of the bladder neck, which removed only the posterior lip portion, was not standardized. Our new procedure sets standards for length, width and depth and also involves a longitudinal dissection at 12 o’clock to match urodynamics. The hospital stay is about 2 weeks, and the cost is about 15,000 RMB if it goes well. 99% of the patients have better results with minimal pain, and the catheter is left in place for 1 month, and is routinely dilated only 4 times after extraction (once in 1~2 days, half a month, 1 month, and 2 months after extraction), with very few recurrences. If you are sure that you want to come for surgery, you should do so. If you’re sure you want to come in for surgery, you don’t need to dilate. I may be on vacation for half a month in mid to late October, so you can come back in November and call before you come, and I can reserve a bed for you in advance because we are very tight on beds.