Health & Fitness

When you gotta go...

When you gotta go.

There are many kinds of injuries people can get. They range from a paper cut to a full-blown dismemberment.

All kinds of treatments have been devised to repair or at least mitigate the effects from the incident.

When I was 19 years old, I had an injury during a Rugby game that still affects me 30 years later.

I will describe the accident, treatment and aftereffects. As I researched this, I discovered the injury is not as rare as I thought. Although I had never met anyone that had this same injury outside of the people that were on the same surgical floor of the hospital while I was recovering from surgery.

It started in 1990 when I was 19. I was attending college in New York. I played spring Rugby. My roommate also played, and it was he that got me interested in the sport. I liked the brutality of it. All the violence of football and none of the protective gear. Ironically the only protective gear that was worn was an athletic supporter with a cup. You will soon see why I say that this was irony.

Jock Strap With Cup
Jock Strap With Cup

In Rugby there were no substitutions. If a player was incapacitated, his team would have to play a man short. Many times, I played through nose bleeds, lacerations or blunt force trauma injuries.

During the 4th or 5th game of the season during the second half we had a loose ball and I raced to retrieve it. A very large player on the opposing team had the same idea. As we ran towards each other I was trying to gain as much momentum as I could with the purpose of knocking him on his ass.

Before we made contact, his knee went up into my crotch, lifting me several inches off the ground and hurling me backwards. He ended up with the ball, but I quickly got to my feet and finished the second half.

I felt pain between my legs but anytime you get hit like that there is bound to be some pain involved. The cup was in one piece and as far as I was concerned it did what it as supposed to do.

In the days that followed I noticed a little blood on my whitey tighties. I just ignored it and after 3 or 4 days it disappeared.

I did not think of it again until months later. I was on a camping trip in Montreal and I discovered I could barely urinate. The stream was reduced to a few drops. It took several minutes to empty my bladder and even then, it never really emptied completely.

When I got back from Canada I stood in the hot shower and let the water hit my nether regions. I slowly became able to pee again.

I knew the problem had to be addressed.

Then next day I went to see my doctor. He prescribed some pills for me and told me I needed to learn to relax. I was going through a lot of turmoil in my life so what he said made sense.

The pills just turned my urine a bright orange, so I was able to watch orange pee slowly drip out. The next thing I did was go to the Urology Clinic at a major urban hospital. It was big and informal. There was not a lot of hand holding. The doctor just listened to my story and matter of factly said I needed to have a VCUG. He said this like “of course everyone knows what a VCUG is.”

A few days later I am back at the clinic. I am in an examination room. There is a big table with stirrups and a portable X-Ray machine. A large curly haired man who identified himself as Gene comes in. He tells me he will do the procedure. I did not know anything about the procedure. This was before the internet was a thing.

I was getting prepared for a VCUG which I find out later stood for Voiding Cysto Urethro Gram.

He tells me what the procedure entailed while I looked at him in disbelief. He tells me he will insert a plastic tube called a catheter into my penis up into my bladder. Then he will attach the tube to a bag of contrasting solution. He will fill my bladder up with the solution. Then he will pull the catheter out and I will pee into a basin and as I pee, he will take X-rays of my urethra and the contrasting solution will show the outline of the inside of my urethra revealing any blockages. It all seemed pretty logical the way he told it. He made it sound like he does this every day of the week. So, I lie back on the table, and he gets to work. He took the catheter in his big hands and tried to insert it into my bladder. I could tell he was having trouble with this. He pulled it out and tried to put some kind of lubricating fluid on it and he tried again. It was a very uncomfortable sensation. He accused me of being too tense. I told him I was trying to relax. Looking back, the logic in this test was flawed. For if I had a blockage in my urethra, the very reason I was there in the first place, what made him think that he could get a large diameter tube past it?

After about ten or 15 minutes he finally gives up. Then he leaves and returns with a catheter they use for newborn babies. After much pushing and cursing it finally goes into my bladder.

He smiled at me as he hooked up the bag of solution. He tells me the hard part was over and apologized that it was so uncomfortable.

I could feel my bladder filling up. It felt like I had to pee. He got the X-Ray machine into place and placed a lead apron over me. As he pulled out the catheter, I peed into the basin he provided. I had not peed so well in over a month. I guessed that the catheter had stretched out the blockage. I really hoped that it had fixed the problem but alas that was not the case. A day or two later and I was back to peeing in drops.

He got some good photos of my urethra. This was before digital imaging so we could not see the results right away.

Male Urethra
Male Urethra

A few days later I went to see the surgeon. I was accompanied by my parents. They had been divorced for a few years, but they were uncharacteristically civil towards each other.

The surgeon was an older man with grey hair. He reminded me of somebody, but I could not think of exactly who it was. He was the Chief of Urology, so I was lucky to have him do the procedure.

He explained that I had what was known as a stricture in my urethra. We discussed that it was caused by some physical trauma. I recalled the knee to my groin area. The cup protected my testicles but the cup itself rested between my legs, exactly where the urethra was. The force of the blow was concentrated in the edge of the cup, exerting all the force into a very small area and crushing the urethra. Scar tissue formed and soon there was a blockage that all but cut off the flow of urine.

Male Urethra Showing a Stricture
Male Urethra Showing a Stricture

The surgeon explained my options. He told me that I could have “sounds” passed through my urethra and that would stretch it out and allow urine to flow again. When he said “sounds” I imagined an ultrasonic device that would somehow zap the stricture out of existence. This was not the case. Sounds are really metal instruments that are physically inserted in the penis. They use a series of increasing diameter sounds to stretch out the urethra. This had to be done every few months however.

Sounds
Sounds

That did not sound like a workable solution. I was 19 years old and did not want to spend the rest of my life dealing with this on a regular basis.

The other alternative was surgery. The surgeon would perform a procedure called a Flap Urethroplasty. The surgeon excises the damaged part of the urethra and places a graft around it. The graft is harvested from surrounding tissue. I would be in the hospital for about 4 weeks and would have to wear a catheter while the urethra heals.

It sounded pretty radical, but it was the best option in my opinion. I can remember my mother asking about my ability to have children. She was assured by the surgeon that I would be fully functional.

I was scheduled for surgery in a few days.

I was admitted to the hospital on a Monday and I was to have the surgery the next morning. My parents both were there and when the gurney came for me I mustered up all my courage and said “let’s get this done.” And gave them a reassuring smile. As I was wheeled into the OR I wondered if I made a mistake. I was hooked up to some monitors and asked to count backwards from 100. The next thing I knew I was in recovery. I was very groggy and just laid there.

After a while the surgeon came in the recovery room. He was wearing scrubs and had removed his mask. I suddenly remembered who he looked like. He had an uncanny resemblance to Boris Karloff. I realized that I had Dr. Frankenstein as a surgeon.

Boris Karloff
Boris Karloff

When I regained my senses, I talked to the nurse and she told me everything went well. I wondered exactly what the whole thing looked like. I peeked under the blanket and saw a white tube protruding from my penis, it terminated into a plastic bag that was hung from the bedrail. This bag would be my constant companion for the next month

My Little Friend
My Little Friend

I was a little upset to think I would have to wear this setup for a month and wondered if I made a mistake. However, as the days went by, I felt better. I was able to walk around, and I had my very own wheelchair. I learned to do wheelies the whole length of the hall.

The month dragged on. I had the procedure in June and could not wait to be able to go outside. Finally, I was told that the next day I would have the catheter removed and would be able to go home. I was brought to an operating room and Dr. Frankenstein was there. The nurse used my catheter to fill my bladder with contrasting solution so they could X-Ray the urethra to see how good the graft came out. As the doctor gently removed the tube I peed into a basin. It was a very strong stream. The surgeon admired his handiwork. I can still remember him saying, “It’s just like a stallion”.

I went home the next day. After a few more weeks I was able to resume normal activities.

I would like to be able to say that I lived happily ever after. That is not the case. After a few years, I began to get urinary tract infections. Usually, every year or two I would get one. A course of antibiotics would take care of it. As the years went by the UTIs became more frequent until this year I have had 4 in seven months.

So last Wednesday I had to have a cystoscopy.

Cystoscopy
Cystoscopy

A cystoscopy is a procedure where the doctor inserts a tube about the size of a pencil into your penis and it has a light and a lens on the end. This lets the doctor see inside the urethra and bladder. He usually looks for kidney stones or bladder cancer. Luckily, I had neither. The procedure was rough as the doctor had trouble getting the scope in but was over in about five minutes.

It was determined that the piece of skin that was used as the graft had hair growing on it. Bacteria collects in the hair and causes an infection. I have an enlarged prostate which prevents me from emptying my bladder completely and that exacerbates the situation.

I was put on medication and will have a follow up visit in 3 months.

Thank you for reading.

When you gotta go...
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