Bladder Urinary Retention, aka. Postoperative Urinary Retention and POUR, is very common and can be precipitated by the anesthesia and opiates administered just before recent operations including lung, prostate, and other operations, especially. if the patient is 60 years old or older..There are other medical profile indicators, ie. high blood pressure, that could also cause the patient to be a high risk for POUR...The Cures include Self Catherization, Behavior Modifications & Techniques, Medications, Neuromodulation, etc......to learn more GO TO anesthesiology wwbsite of the Journal of the Society of Aesthesoologists......A lot of surgeions are unaware or have forgotten that POUR is a high risk for specific and primarily older surgery patients.....FYI - I have POUR that was precipitated by the items mentioned above during a lung cancer operation in June, 2016...Neither the lung surgeon nor 2 urologists since know how to treat the POUR...As a result, I've been on a Direct Straight Catheter since the operation, because my bladder muscle will not function and, as a result, I can't VOID, Pee, as I should......This information may help you if you are experiencing Urinary Retention too...I hope this hel;ps!...
Hi Randy,
Sorry to hear what happened. Don't know your history, but my guess is that you probably had other underlying issues such as bph prior to the surgery and that the anesthesia pushed you over the edge into rentention. Could be wrong on this.
But in any event, three months is a long time to be on an indwelling catheter (Foley) because you can't void on your own. At this point I would ask to be put on a program of self-catherization (CIC). It's a simple and easy way to empty your bladder completely without having to have a tube in your urethra and wearing a bag. I personally have been self cathing for around 3 years now and can attest to its effectiveness.
Self cathing also allows you to use your bladder (detrussor) muscles so I would think if you have any chance of regaining your previous bladder function, self cathing would offer you a better chance than just using an indwelling Foley where the muscles aren't exercised at all. I would also consider getting another opinion from a voiding expert as your current doctors don't seem to have any answers. But first get off that Foley, learn CIC, and start to live more of a normal life.
Jim
Hi Randy,
From my experience, constipation can aggrevate urinary retention just as much as BPH.
Blocked up feces can pinch on the urethra just as much as the prostate squeezing on it.
I suffered from both BPH and constipation, now only BPH.
I currently self cath (thanks to jimjames, he inspired me and many others)
3, 4 times a daybecause of the high retention even though I can void normally.
I tried to avoid constipation by watching what I eat and consume more fruits and vegetables.
I am also taking 4mg Doxazosin and 5mg Finasteride daily, waiting for a miracle drug or surgery.
Hank
What you describe is common, but usually resolves in a couple of weeks. You should see a urologist about it - and would be much better off self cathing at this point, As long as your on a Foley, your bladder won't get any excercise or improve. If you self cath, you can try to pee each time and after awhile, you'll start to be able to - slowly at first. Some PT to get the muscles working again might help too.
Hi Hank,
Glad the self cathing is working out and happy I was of some help. As long as you're self cathing 3-4 times/day why not drop the Doxazosin and Finasteride and see how it goes? Even if it meant you had to cath another 1-2 times/day, it might be worth it by ridding yourself of the side effects of the two drugs.
Jim
Thanks Jim,
I think I will try just that. I will slowly decrease dosage of Doxazosin to 2mg a day first and see how it goes.
If can can still void naturally then I will go further.
Anyway, you are my hero from what you contributed to this forum. You made a big difference to many of us, in a positive way.
Hank,
I would give it at least a few weeks or more, even if your natural void decreases, even signficantly. A decreased natural void shouldn't do your bladder any harm as long as keep total volumes in your bladder under 400ml one way or another, regardless of what per cent of the void is natural versus catherized. That volume can easily be controled by your cath frequency. Also keep in mind that it may take a little time for your system to adjust to being off your current drug dosage, so you may find the natural void volume coming back after time. .
But even if it turns out that you need to up your cath schedule longer term, I think you owe it to yourself to find out whether your life is better off with a more frequent cath schedule (and without the drug's side effects) or whether it's better off now with the drugs. Or maybe something inbetween.
Jim
My urologist advises against self cathing due to the nature of my medium lobe. He states I have to negotiate a curve and current catheters can't do that. Thus, he says I would injure myself by trying to self-cath.....He, a prior Uro, and my lung surgeon Do Not and Did Not offer a treatment for POUR and seemed not even to be trained for it or aware of it...Question - I've had a REZUM which should releave the pressure on the urethra so it can function normally....Thus, it seems my VOIDING PROBLEM is caused by the Bladder Muscle not functioning as it should when we try TRIAL VOIDS. ...There are medications and neuromodulation that are suppose to stimulate the bladder muscle so it will perform...I'm trying to contact a POUR Specialist now....
The only way to tell if you're median lobe is the problem is with a scope - he's just guessing.and you're far enough past the procedure that it should be down in size at least somewhat. And remember, everyone who self caths due to an enlarged prostate has something that the cath needs to navigate around, otherwise they'd be peeing the normal way.
Curved tips (Coude) were desgined for that problem and the only way you'll know if you can do it is to try - I'd be shocked if you couldn't this far after the procedure. When I had Rezume, there was one spot that almost always cuased a problem, but I cound that a certain angle with the curved tip did the trick. And remember, if that lobe precluded you from self cathing, how is it they're getting that Foley (typically much larger thant the 14s most people use to self cath) up there every time? Those pre-lubed speedicath 14 slide up there very nicely - much more easily thatn anything they use in hospitals or doctor's offices.
Bottom line - you can already pee some (as eveidenced by your problem on the way to the docs office) and you won't get better until you excercise your bladder. Find someone who will show you how to Self cath and write you a script for caths and this nightmare will probably be over in a matter of weeks - and in the meantime you can live normally. If you wait, you'll be on that Foley indefinitely, because a domrant bladder won't return to normal function without being used and excercised.
Time for a new doc IMO.
Hi Randy,
We're not doctors here, but I will tell you this from my personal experience that the majority of urologists know very little, and have very little experience with self cathing. And your doctor is not even currently a urologist -- a "former" urologist you say, now a lung doctor!
His take that "(you) would injure yourself" with self cathing due to the nature of your median lobe, doesn't sound right to me at all. Could it be As mentioned by "oldbuzzard", there is a catheter designed to go around difficult and enlarged prostates. It's called the "coude" catheter. My recommendation would be to start with the Speedicath Coude Tip size (FR) 14 by Coloplast. If for some reason that doesn't go around the prostate you could try another size.
You owe it to yourself to at the very least get a second opinon on this ASAP from a urologist who is familiar with self cathing. You might want to look for someone in a teaching hospital who treats SCI (spinal chord injury) patients. Self cathing is their go-to method of emptying the bladder.
Jim
Can you provide the information to order Coude Caths? ...Or do I just Google Coloplast?......Doesn't someone, ie. as nurse, have to teach you how to Self Cath?...FYI - I've just set-up an appointment with another Urologist to discuss (#3) Self Cathing and other POUR treatments.....You misunderstood the doctors I've seen...#1 Lung Cancer Surgery June, 15 which caused the POUR, #2 URO DOC #1 who ignored the POUR Complaint ran tests and wanted to do a TURP Only. I Decined the TURP, #3 URO Doc ran tests performed REZUM on Agust 15th...No Improvement for Retention, I can't VOID.....The REZUM should have removed enough tissue to correct the BPH, but it did nothing to help the Bladder Muscle...If the Bladder Muscle doesn't push the urine through the urethra, then, I still won't be able to VOID, even if, I Self Cath...Isn't that true?...I could SELF VOID without any problems before the Lung Operation, but have not been able to since...I may have had a BPH problem that needed the REZUM procedure, but it seems like both URO DOC's have ignored my initial complaints to cure the POUR so I can VOID normally....
Hi Randy - just want to ditto what all the guys are saying here about self-cath. I had a failed PAE 10 weeks ago and had suffered AUR a few times. I do not have a median lobe but my prostate is 300gms and my PVR is 300ml. Jimjames and the gang saved my life. The coude tip is the key. Please do yourself a favor and try their advise - it is better than all the uros in the world. Good luck. Neil
Self cathing will work regardless of the state of your bladder. People paralized above the waist are able to do it just fine. IF you had no issues prior to surgery, then the Rezum may have been unnecessary, but given your situation, a prostate that wasn't a problem before might be now, given the state of your bladder. And you'll need a prescription in order to order a catheter.
Bottom line is you need to excercise your bladder and get it moving again. The kind of problem you had post surgery shouldn't last more than a couple of weeks - hopefully your new doc will understand the situation and treat it. If you can pee some, chances are with excercise (try to pee every time - then use the cath to empty) you'll be functional before too long.
Hi Randy,
The catheter many here recommend is Speedicath Coude 14F. Product number: 28494. HCPCS Code: A4352.
Ideally, your doctor or nurse will show you how to do it. Unfortunately, many do not have the experience. Fortunately, many videos YouTube, some from Coloplast. The main thing to keep in mind is to be very gentle and never force anything. You also want to make sure to orient the coude tip properly per the videos or your instruction.
Self cathing will not necessarily solve your problem, just like your Foley won't necessarily solve your problem. But what it will do is free you of tubes in your urethra and a bag on your leg so that you can live a better life until your problem gets solved.
Let us know if you end up with catheters and a number of us can help you with further questions that may arise.
Jim
Forgot to mention that the manufacturer is Coloplast.
Thanks Jim,
I do not have much side effects from doxazosin and finasteride (maybe not yet). Yes, there is RE which I do not mind. And the low blood pressure and dizziness which I resolved by increasing my sodium intake (still fairly low comparing to the average).
So I am not really desperate to cut down all the meds yet.
By the way, I am also thinking about reducing my liquid intake to lower my retention. Right now I am taking about 2 liters of liquid plus foods (with a lot of fruits and vegetables). What do you think ?
Hank
'Jimjames and the gang'. How endearing yet accurate. Hah hah.
Hank
I greatly appreciate you and Jim James helpful suggestions. My current URO doc is anti-Self Cathing and that may be a solution so I guess I need to change URO Docs for the 3rd time...Self Cathing is "one" of the "helpful treatments" for POUR, Postoperative Urinary Retention, mentioned in clinical trials... The Two of you plus most all the men on this forum endorse and recommend the Self Cathing so, if I can find a URO Doc who'll prescribe the catheters and teach me how to use them, I'll try it...I Don't Have Much To Lose!....Thanks, Guys!...
If possible, start looking at a teaching hospital. A call ahead to the doctor's nurse prior to the appointment can also be helpful. Ask the nurse if the doctor has self cathing patients and if he supports and writes rx's for self cathing when needed. If the answer is "no" or non-committal, call another doctor. You could also try finding a urologist who caters to the SCI (spinal chord injury) community. In the SCI community, cathing is the go-to method of bladder emptying, so any urology practice serving that community should have experience in self cathing.
In most cases self cathing is far superior to an indwelling catheter. But if for some reason it doesn't work out for you, then Plan "B" would be a Suprapubic catheter with possibly a flip-flo valve. Again, this is oftenbeyond the "pay grade" of your garden variety urologist so seek out a large teaching hospital.
Jim
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