5 Weeks After Green Light Laser Surgery my Catheter Is Still In

Men's health
1

Hi All

Im posting on behalf of my Dad and really would appreciate any advice.

A bit of background info for context - my Dad who is 77 got admitted to hospital 10 months ago with Acute Urinary Retention.  They inserted a catheter to drain the urine and after many months of investigation they diagnosed BPH as the cause.  After many TWOCs it became apparent that he would need to have a long term catheter fitted and go on a waiting list for either Green Light or TURP.  The hospital where my dad got operated on tried to persuade him to go for TURP because they hadn't performed many Green Light Surgeries. 

After much consideration he opted for Green Light in the hope that it would be be less invasive and would recover quicker.  By the time his surgery took place in August 2015 he had been on a long term catheter for 9 months.  He had Green Light Laser surgery 5 weeks ago.  Less than 24 hrs after his op they removed his catheter and he couldn't pass urine at all.  It took 4 attempts to insert a size 10 catheter. They discharged him with the catheter in place and told him to come back 2 weeks later to have it removed. 

When they removed it he was able to pass urine and they sent him home.  His flow wasn't great and 3 days later he had to go back into A&E as he couldn't pass more than a dribble and he was in pain.  By the time they catheterised him he had over 850 mls in his bladder. They kept him in and said it was probably a blood clot obstructing flow or a lazy bladder and sent him home with a self tap catheter in order to re-train his bladder. 

Yesterday he went in for a TWOC and although he passed urine well for the first hour, after 3 hours he couldn't pass any urine at all. They had to re-catheterise him and have said he needs to have a cystoscopy in order to determine what is causing the obstruction. The only thing is, they have said that it might take 10-12 weeks to get an appointment!! If that is the case it'll be a year since he first had a catheter fitted.

My dad is so disheartened.   Is there anyone out there that has had to have a catheter in for so long before and after surgery and does anyone know what could be stopping his urine flow in this sporadic way?

He is fearful that he might have to go back in for more surgery which he really doesn't want as this has all been really hard on him.

Can anyone offer any advice?

2

I don't know where you are located but it appears that physicians in your part of the world don't know too much about BPH. It would appear that not much tissue was removed from the prostate. TURP might be an improvement over Green Light but the recovery period is just as bad. You can probably learn more from reading these posts than you can from your doctors. Look into 2 newer procedures. They are HoLEP and PAE. Both are effective and have short recovery periods. However because they are fairly new, it is unknown how long they will be effective. Furthermore you may have difficulty finding a doctor who can perform these procedures. I am sorry to hear about your dad and I wish him luck. Keep me informed.

3

Until they sort things out, you should ask his doctors about either self catherization (CIC) or a Suprapubic Catheter. Either one can re-train his bladder as well as a Foley Catheter, without as much discomfort. I did CIC for two years and it hardly affected my lifestyle. I could not imagine having a Foley Catheter in that long, or even the 9 months you mentioned.

Jim

4

As a 71 year old, I first want to say how good it is to see you watching out for your father's interests.  If I correctly understand TWOC, and by inference of your use of "Guardian", it would seem that your father isn't fully capable of either doing some things himself, or making correct and informed decisions.  CIC (self-cath, with disposble catheters) is a surprisingly simple procedure, and I've been doing it for about two years.  But if Dad isn't capable of doing this himself, it presents challenges.

As suggested in previous replies, BPH is a well-understood condition, with plenty of urologists able to diagnose and treat, either medically (Avodart, Cialis, plus Uroxatral, or Flomax, opr Rapaflo, or others), or catheterization (ideally CIC), or the last step, surgically.

Your father may be less concerned about the potential (some would say probable) side effects of various surgical procedures, and that might be the option which was pressed upon you, or him, by urologists or others.  The fact that he has had apparantly unsuccessful surgery, though, would have me concerned about the quality of his care to date.

Does he have any options about where his procedures are done, and which surgeon would do the procedure?

My only experience is in the US, and I have both Medicare and, as a retired military officer, Tricare as my health insurance providers.  That means I can go to any Medicare-qualified hospital (almost all, but particularly the best ones) and use any Medicare-qualified surgeon or urologist, or even other specialists, such as a nephrologist.

What are your Dad's options?

5

Hi lester90053

Thank you for your post.  We're in the UK and therefore at the mercy of the NHS (which I have to say is a brilliant thing - it just doesn't seem so in my Dad's case).  My Dad was informed in March 2015 when he finally got to speak to a Consultant at the hospital he had been referred to, that most NHS hospitals only do TURP and by chance they had one Consultant in their Urology team that did Green Light.  The only hospital that performed HoLEP was a fair distance away and if he wanted to go ahead with that they would have to refer him and wait at least 3 months to have an initial consultation about the HoLEP procedure.  By that point my Dad was happy to go ahead with Green Light because he didn't want to wait any longer.  

My Dad doesn't have private medical insurance and so the only way to cut that wait time down would have been to pay £5k to have the procedure done privately.  With the limited information he had he made the best choice he coul at that time.  I guess the only choice he has now is to wait on the NHS or pay to have a Cystoscopy done privately....

6

Hi Jim

Thank you for your post.  My Dad was offered the choice of having a CIC but was told he would have to do that twice a day.  He felt nervous about doing that (he's always been very squeamish about medical stuff) and so opted for a normal catheter instead. How often did you have to self catheterise?  Having a long term catheter has had an enormous effect on his lifestyle and confidence.  He hasn't left the house much to do anything in the past 10 months....

7

Hi Carry-on CMDR

Thank you for your post. This whole process has been massively frustrating for all of us.  As I mentioned to lester90053 we are in the UK and the NHS is notorious for long waiting times.  I've always had a good experience with the NHS and value it's service, but I do think that my Dad's Consultant who did his Green Light surgery is an arrogant man who has no time to talk to patients.  My Dad saw him once for 10 mins 2 months before his op and hasn't seen him since! 

My Dad is mentally compus mentus and physically fit - he retired from his work as a Civil Engineer at 73 only because his position was made redundant.  And he's never had a period of ill health til now - which I think has knocked him for six and maybe left him feeling weary and not sure what decisions to make - I posted as Dad Guardian because I'm very protective of him and am desperate for him to regain his independence and confident manner as he once was.  TWOC is trial without catheter which he has had many of and hasn't had much success at.

It's very positive to hear that CIC is easy and has worked for you, how many times a day do you have to do it?  Maybe CIC in the interim while he either waits for a Cystoscopy on the NHS or pays to have one done privately would be the best option.

8

I'm presently doing CIC four times a day, but began at three per day in October 2013. It is something I resisted, but wanted to avoid surgery, if possible.  The new hydrophillic coated silicone catheters are painless, and cause just a bit of discomfort.  Once I agreed to go with CIC, the nurse for my urologist did the first procedure, showing me just how to break the sterile water packet contained inside the sterile catheter packaging, and she did the first insertion.  I did everything after that, and within a few days it was easy and simply repetitive.  The concept is what makes many men, me included, metaphorically gag.  The idea of sticking something up the second favorite part of my body was my mental barrier, and, when telling friends of my age about the procedure, one can see how mentally uncomfortable it is.  But it's really quite simple.  

My urologist ordered the catheters for me, and mine are called "Magic 3" and are manufactured by Rochester Medical Corporation, but many companies apparently manufacture a similar product, and Rochester apparently sells in the EU through Medical Product Service in Braunfels, Germany.  There are a few different sizes, which the urologist will determine, but for information purposes I use the 14 FR/CH, male 16 inch (no, that's the catheter length...darn).

Tell your Dad it's much easier than he imagines.

His issue, though, since surgery seems to have not been successful, could well be whether any scar tissue or other physical obstruction is blocking something in the bladder/urethra process.

But, if that's clear, than CIC is easy.

When travelling, as your Dad might wonder, I just carry with me a kit (containing one catheter, one anti-bacterial wipe, and an opaque cheap and disposable plastic bag) for each CIC I won't be able to do at home, that day, or for "x" days on an extended trip.  

9

Really GL should not give him a problem. Most people sail through it as day surgery. I had it late afternoon for a 75gr prostate with the catheter out the next morning. I travelled home by train the next day and the following day went to the races.

In 2013 after eight years when I was 79 it had regrown to 130gr and I had Holmium laser as that was what they were doing along with TURP where I now live.

As I was still passing blood the next day they sent me home with a cathter in as they needed the bed and I was told to come back in two weeks to have it removed. I caught an infection while the catheter was in but had no problems after it was removed. The surgeon was annoyed that it had been left in for so long and said that it was only supposed to be for a week.

10

I should add that I was the 8th patient of the one who did my GL and I had no worries about his competence. Between the four Uro's at the hospital I was the 38th patient. 

11

It's quite normal to initially feel "nervous" about CIC. I don't think anyone was more squeamish than myself, in fact I almost fainted the first time the nurse helped me do it! That said, after the initial "break in" period which varies from person to person, it starts to become second nature. When I say it's no more traumatic than brushing my teeth, I am not exagerating. And it actually takes less time!

I have been doing CIC for over two years now and can say that it not only didn't affect my lifestyle, but it actually made it better than before when I was always rushing to the bathroom because of retention issues. 

My CIC schedule was initially 6X/day and then later on I was able to decrease it to sometimes once or twice a day. Sometimes even skip a day. 

As mentioned in another post, I had my best results with a Hydrophilic Catheter, and I tried many. Specifically I use the Coloplast Speedicath with a Coude tip. The Coude tip recommended for anyone with an enlarged prostate to help the catheter navigate around it better. I started, like most, with size 14F, and later switched to 12F, which takes more practice to use but it's a smaller size. A good rule of thumb is to use the smallest size catheter that you can work with. 

Happy to answer any more questions you may have about CIC, and you might want' t check out a few threads I started on the subject elsewhere in this forum.

If for some reason CIC doesn't work out, then a Suprapubic Catheter with Valve would be the next choice. The Supraubic drains directly from the bladder so no catheter in the urethra. And because of the valve, you don't have to carry around a bag, you just empty it into a toilet whenever you have the urge to urinate. 

I prefer CIC, but either one of these two alternatives would give your dad the same type of freedom he had prior to wearing a full-time catheter. It's a shame his doctor didn't offer choices but not surprising from what I've read here. 

Jim

12

It's great to hear someone else is having success with a CIC program. Rather than turn this into a CIC thread, I will post some comments and questions regarding your post in this CIC thread here. Give me 30 minutes or so. 

https://patient.info/forums/discuss/self-catherization-an-alternative-to-turp-greenlight-holep--336874