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Medical Forum / Diseases and Disorders / Prostate BPH / January 2006Would it be possible to resolve acute urinary retention by stimulating the prostate?
Like some other people with enlarged prostates, I go into retention when my bladder is too full. A catheter relieves the condition, but is invasive and poses the risk of bladder infection. It would be great if there was a simpler way. The last couple of times I have been catheterized for retention I experienced an intense feeling of urinating when the catheter reached a certain point (I'm guessing the prostate). A couple of seconds after that, urine flow began both THROUGH the catheter and AROUND the catheter. It seems that the sphincters were stimulated to open, allowing urine to flow. If the catheter had immediately been removed, probably flow would have continued, but of course that wasn't done so I don't really know that. Why does an over-full bladder cause retention? I have been told, it's because it takes a greater force to squeeze a body with a larger diameter, and the bladder muscle is not up to it. That makes good engineering sense, but I wonder if there is more to it. I suspect that the nerves might be confused too. This would make it hard for the brain to "find the trigger" to start peeing. I've certainly experienced that with an over-full bladder. If that is the case, then stimulating the area such as was done by the catheter might cause urine to flow. So my question is, is there any basis for thinking that this is so? And if so, could the nerves be stimulated in a convenient way, such as by contacting the so-called male G-spot (via the rectum)? Okay, this is done for sexual pleasure too, but any experience in facilitating urine flow? Any recommendations of the best way to do this, or how to test this? Ed Ed, You are in a relatively bad situation. There are five situations considered an absolute indication for surgery for BPH: - refractary (repetitive) acute urinary retention - chronic retention with hydronephrosis - recurrent bleeding due to BPH. - bladder stones - renal insufficiency caused by BPH - recurrent urinary tract infections. In other cases, the indication for BPH is relative, and depends on patient's quality of life and preferences. So you would fall in the first category of patients, and instead of trying to look for a way around surgery, you should consider having surgery for your BPH. Muscle physiology studies show that overstretching of muscle fibers causes weak contractions. If you go to the gym and try to work your chest lying down, if you stretch your pectoral muscles too much, the first part of the movement is very difficult. After you have lifted about 15 cm, and the bar is not touching your chest, the contraction becomes much more powerful. Another factor is an obstructive median lobe. If the bladder is full, the median lobe is pushed against the prostatic urethra, blocking it. A nice way to handle your problem temporarily is intermittent self-catheterisation, this must be taught by a doctor, and you have to use special catheters. The beauty of this is that the risk of infection is very low, and that you are independent, if you have this problem, you catheterise immediately and the problem is solved. You do not have to go to an emergency department. But, as I said, you need to solve your problem, and now there are easier ways to do this, as it happens with Photoselective Vaporization of the Prostate.... Animal studies have shown that acute retention of urine causes overdistension of the bladder and damages bladder inervation permanently, this means you can develop a weak bladder as a result of repetitive retentions, so be careful and visit your urologist. All the best, Fernando Gómez Sancha http://drgomezsancha2.blogspot.com Thank you, Dr. Sancha. I live in Alberta, Canada, and PVP has not arrived here yet. Dr. Baldwin in Toronto does PVP. I visited him. He did not recommend a PVP for me because of my large prostate (150g). So my alternatives are limited. My urologist has mentioned open prostatectomy (but has not recommended it yet). Going outside the country for a PVP means very high expenses and logistic problems. If I do this, my current urologist may drop me. Still, I am considering this. In the meantime, I think my condition is under control. I'm on Flomax and proscar. I do self-catheterization (needed once or twice a year)... produced volumes are low (400-600 cc) and there is no blood. If I wait, maybe PVP will come to Alberta or better techniques will be developed. Your comments are welcome. Ed >Ed, > [quoted text clipped - 40 lines] >Fernando Gómez Sancha >http://drgomezsancha2.blogspot.com Ed, I wonder how old are you. PVP can be used to treat large prostates. I have operated about 30 patients with prostates as big as yours, some of them almost three years ago and they are almost all doing fine. Two patients from the first ones I operated did not improve as much as they expected, due to the fact that I found it terribly difficult to operate in such large prostates during my learning curve, and the amount of tissue I vaporized was probably not enough to fully improve their situation. I have offered one of them to do a second stage and complete the job. The other patient did not improve totally, but his life is more bearable now and does not want to hear from another operation for the time being. But now I am better at treating large glands, specially because I use a suprapubic trocar to aid with irrigation in these cases. Normally the irrigation power of the small calibre instrument we introduce in the urethra is rather limited, and this can make the procedure more difficult, if there is blood or debris from vaporization in the optical field, then the operation gets more and more difficult. I found this suprapubic catheter to be a great advantage, because it enhances irrigation, and you can vaporize tissue non stop for as long as you need. This leaves a 5 mm wound under the umbilicus, that is usually no problem for patients. The biggest prostate volume I have operated on was 200 cc, also with good results. In order to be effective, one needs to spend at least three hours in theatre, and I use three to four laser fibers, delivering close to 800.000 joules. This makes it a costly procedure, but still it is safer than an open prostatectomy. This can reduce a 150 gram prostate to about 50-60 grams. This means there is still residual BPH tissue, but the prostate is hollow, and the obstructive tissue is not there anymore. Age is important, because if you are 60 years old, you might live long enough to experience tissue regrowth. But if you are 70, probably this operation could be definitive. This is my opinion, we do not know yet what is the outcome of PVP in patients with big prostates in the long term. What is clear to me is that PVP is a safer option than an open prostatectomy. Open prostatectomy is a great operation, the results are excellent providing you do not suffer the morbidity it can cause. It can cause blood loss needing transfusions, impotence, incontinence, even when the surgeon is an expert surgeon. You need to stay 4-5 days in hospital, carrying a catheter.... it is quite a big undertaking. Probably 8 or 9 out of 10 patients fare well, but one or two will experience problems... So I guess if I had to operate my father, whose prostate is about 130 grams, I would recommend a PVP performed by me or by a surgeon with extensive experience with large glands. The chances of improving his quality of life would be very high, with minimum morbidity... And I would want my father to be safe above all other considerations. I hope this was helpful... All the best, Fernando Gómez Sancha http://drgomezsancha.blogspot.com [snip] > A nice way to handle your problem temporarily is intermittent > self-catheterisation, this must be taught by a doctor, and you have to > use special catheters. The beauty of this is that the risk of infection > is very low, and that you are independent, if you have this problem, > you catheterise immediately and the problem is solved. You do not have > to go to an emergency department. I taught myself to self-catherize using the instructions at the LowFric website. What would a doctor have told me differently? I use FR#10 16in catheters... what special catheters are you referring to? I'm not trying to challenge you or be argumentative. Just curious. PS: Ben Franklin used a reed... ouch!  SignatureNelson >> A nice way to handle your problem temporarily is intermittent >> self-catheterisation, this must be taught by a doctor, and you have to [quoted text clipped - 12 lines] > >PS: Ben Franklin used a reed... ouch! I learned by watching them catheterize me in emergency. Catheters can be bought here without restriction, so it was easy to set myself up. I have used 14Ch/Fr... not sure if they are the best, but they work. At the time I was defying my uro. He did not want me to self-cath. Big problem, because he was the expert and I wasn't. But I thought about it and defied him. Now I have a different uro who encourages it. Before this, I used to depend on the emergency dept when in retention, but they were SO slow (2 hr delay), I was in extreme discomfort and bladder wall was bleeding by the time they relieved me. Now I do it myself, volumes are much lower, no blood, and much less stress for the bladder. Plus, I can now deal myself with certain potentially very awkward situations (hypothetical for now) like experiencing retention in the middle of a 9-hour intercontinental flight, or in the bush hours away from help, or just before an important business appointment. Note, if you are contemplating trying this -- there is a risk of infection and other risks - know what you are doing, and get the cooperation of your doctor first -- you bear all the responsibility yourself. Ben Franklin's reed might have been painful, or not. He would probably have used butter with it, and it would be much preferred to the alternative, which was suffered by Thomas Jefferson. Ed I recommend astra tech's Lofric catheters. The caliber is not so much of an issue, as long as you tolerate it well, 14 F drains slower than 16 F. No big deal. As I said, self cath can be a way out of retention, but if you are having repetitive retentions you need surgery!!! All the best, Fernando Gómez Sancha http://drgomezsancha2.blogspot.com Dr. Sancha...do you have a conversion factor for converting French (i.e. 14,16, 18, etc) to a metric or English diameter. I have searched this on the Internet and asked my uro in the past (who doesn't even know that one ounce equals approx. 30 ml), and came up empty. I believe I have asked this group before and no one cares. I care. What I do know is they put a 22 F catheter in me after my TURP last April and the son of bitch almost killed me for 3 days (I told them in the surgical suite recovery room I couldn't handle it and I wanted it out - you talk about a feeling of urge - wow! - lasted 3 days non stop - then for 3 months afterward, but not as bad as when the cath was in, of course). I told you before the damn TURP just exacerbated my prostatitis. Anyway they just kind of laughed at me and sent me home. The 22 F. cath measured close to 9/32" diameter, which is almost exactly the size of a pencil (nice thing to have jammed up your penis for three days, and some people have them a lot longer than 3 days, but I would hope they would put a smaller one in after the bigger chunks of debris drained out - lol). The thought of ever living with a catheter, or a bag directly connected to my bladder or intestine of any kind scares the hell out of me. Let me know if you can find a conversion factor please. I haven't forgot about my kidney questions that I will be posting. BTW it sounds like you do not agree with the self taught self cathing that Nelson mentioned, even though you didn't say so. Am I correct. Thanks again...Pete > I recommend astra tech's Lofric catheters. The caliber is not so much > of an issue, as long as you tolerate it well, 14 F drains slower than [quoted text clipped - 7 lines] > Fernando Gómez Sancha > http://drgomezsancha2.blogspot.com > Dr. Sancha...do you have a conversion factor for converting French (i.e. > 14,16, 18, etc) to a metric or English diameter. I have searched this on > the Internet and asked my uro in the past (who doesn't even know that one > ounce equals approx. 30 ml), and came up empty. I believe I have asked this > group before and no one cares. I care. Pete, Is this what you are looking for? http://www.chaseunion.com/documents/urethra/onesize.htm >> Dr. Sancha...do you have a conversion factor for converting French >> (i.e. 14,16, 18, etc) to a metric or English diameter. I have [quoted text clipped - 8 lines] > > http://www.chaseunion.com/documents/urethra/onesize.htm Thanks Rich...I have bookmarked it and will save it to my hard drive also (since web pages don't last long these days). How the hell did you find it. It was a while back, but I did all kinds of search strings and came up empty handed - I feel like a schmuck now - lol . Anyway how did I do - I said my FR 22 cath measured 9/32" (didn't want to get into 64's - and I didn't have an engineering scale handy at the time), and that is .28125 versus the actual French conversion of .2882. Pretty damn close <g>. Incidentally I have built all the furniture in my house and am pretty good at measuring stuff :-) . Take care and thanks again...Pete > >> Dr. Sancha...do you have a conversion factor for converting French > >> (i.e. 14,16, 18, etc) to a metric or English diameter. I have [quoted text clipped - 19 lines] > damn close <g>. Incidentally I have built all the furniture in my house and > am pretty good at measuring stuff :-) . Take care and thanks again...Pete 99% luck: Try a search for: Catheter size chart Or: Catheter size chart prostate Lots of information. >>>> Dr. Sancha...do you have a conversion factor for converting French >>>> (i.e. 14,16, 18, etc) to a metric or English diameter. I have [quoted text clipped - 27 lines] > > Lots of information. That's very inventive Rich. I think I tried everything but that :-) . Talk to you later...Pete > I recommend astra tech's Lofric catheters. I looked at tho$e and liked the idea, but they are $ingle use. I am, how do you say, income challenged :-) So I stold some of my wife's :-) She has MS and has to cath every time. I am aware of the infection danger but reuse hasn't been a problem with her... we are just careful to wash with a disinfectant soap every time and hang the sucker out to dry. > The caliber is not so much > of an issue, as long as you tolerate it well, 14 F drains slower than > 16 F. No big deal. Time I got :-) > As I said, self cath can be a way out of retention, but if you are > having repetitive retentions you need surgery!!! Yeah, well that's what my urologist says too. And it may come to that. However, after watching my wife doing it every time for the last year, I'm starting to wonder. I wonder if anyone has ever quantified the risks of self-cath vs the risks of surgery. I have never heard of anyone becoming incontinent, impotent, or have retrograde ejaculation from self-cath :-) My lifestyle, such as it is, makes self-cath a practical alternative. It would probably be different if I were employed. I would recommend everyone with BPH learn how to do it. Not necessarily to do it regularly but to have as an alternative as a backup in an emergency. One trip to the emergency room can pay for a lot of Lowfrics. I am currently awaiting the results of second PSA test so this might all be academic for me anyway :-( SignatureNelson >> As I said, self cath can be a way out of retention, but if you are >> having repetitive retentions you need surgery!!! [quoted text clipped - 8 lines] >lifestyle, such as it is, makes self-cath a practical alternative. It >would probably be different if I were employed. This is what I was thinking too. Self-cath once a year or so is pretty mild compared to surgery. But one should also compare the risks of surgery to the risks of doing nothing. And gradually I'm realizing that the latter carries risks too... like secondary effects on the bladder and kidneys because of higher pressures, increased risk of kidney stones, etc. Plus, consider complicating effects if you develop an unrelated condition. I ended up with an infected tooth and am taking Clindamycin (antibiotic) for it, requiring lots of water, so I'm getting up 4 times a night instead of the usual 2 times. What if I got a heart attack? Can't do self-cath then. Just stuff to think about. Ed Just another point of view... My 72 yr old brother did exactly what is proposed in this thread...he self cathed himself when he got into retention. He has been having this retention problem for the last 10 plus years. However, now it has progressed to the point that he can no longer deal with the retention with the cath. It is happening too frequently. He had the usual examinations (Cysto, TRUS, Flow test) and found that his prostate has grown to over 100 grams. TUMT is ruled out because of metal mesh used to repair an inguinal hernia. TURP is out because of the size of his prostate. His URO sees no solution except to do an Open Prostatectomy which is major surgery. Do your research on the net about Open Prostatectomy and see what the risks are for that type of surgery. My TUMT and PVP on my 35 grm gland were not perfect in their outcomes. I am scheduled to see the URO Monday about possible further ablation of the bladder neck. That seems to be a less invasive procedure compared to what an Open Prostatectomy would be. We all make the best decisions we can with the information we have. I wish to avoid an Open Prostatectomy if at all possible. >>>As I said, self cath can be a way out of retention, but if you are >>>having repetitive retentions you need surgery!!! [quoted text clipped - 26 lines] > > Ed >Just another point of view... > [quoted text clipped - 10 lines] >Prostatectomy which is major surgery. Do your research on the net about >Open Prostatectomy and see what the risks are for that type of surgery. So are you saying he should have had prostate surgery maybe 10 years ago to avoid the situation he is in at present? Why not PVP for him? Open is major and serious, but I understand that it gives the best long term outcome of all the procedures. Ed My message is simple...in 2006, if you have bph, there are options for dealing with the problem...PVP being one of them. Deal with it before you become an Open Prostatectomy candidate. Some will elect to use the alpha blockers and Proscar type drugs with success; that certainly is their choice. Others elect TURP or PVP. In his case, I have given him information about PVP including names of local docs doing PVP and information about Dr Te who operates on large prostates. He has made the choice to go with his local URO who will do the Open Prostatectomy. >>Just another point of view... >> [quoted text clipped - 20 lines] > > Ed Nelson, Ed, Chockman and others, Let me ask you a question that may help me orchestrate my upcoming questions to Dr. Sancha on the kidney and urine production at different times of the day and conditions. I have never self cathed and don't need to presently, but I have some perineal problems at best if you recall anything I have been writing in the past, and I believe there is a crossover between BPH and the continuum of prostatitis, urethritis and cystitis. I have mentioned this many times. At what point to you guys self cath. Is it based on a time schedule - obviously not in Ed's case, since he does it once or twice a year, or do you cath when you feel a strong urge or discomfort, or do you use the "press on your belly test" to see how bad it feels. I have used the so called press on the belly test ever since I was a kid, but it may not be a good indicator for some people, that's why I am asking. Let me ask in relation to this, can some people have their bladder fill up but be oblivious to the pain or discomfort which is the body's normal warning system that it is time to go (I don't mean major nerve disorders - i.e. are some people just more insensitive and do not get the urge feeling). This could be dangerous due to kidney backup, etc. I am always worried about backup to my kidneys and infection in the bladder and urethra in general, especially due to my immune deficiency, and I am always concerned about not being able to void as good later in the day and at night. It is not a simple matter of BPH. I will be writing about this in my upcoming post to Dr. Sancha. I hope you know me well enough by now not to tell me to go to a doctor (I have become familiar with most of the regulars in here). I hate to keep being repetitive and telling everyone my conditions and past surgeries over and over, but that's all I do is go to doctors and have been to my uro's factory over 20 times in the last year, with not a lot to show for it...Pete >> I recommend astra tech's Lofric catheters. > [quoted text clipped - 32 lines] > I am currently awaiting the results of second PSA test so this might > all be academic for me anyway :-( Pete... My experience with self cath is limited to the one week periods following TUMT and PVP when I felt the need to cath because I could not urinate normally or felt pressure at bedtime that the bladder was still not empty. On both procedures my URO sent me home without a cath installed but gave me the materials to do so if I felt I needed it. And in both procedures I did need it for about one week after the procedures. Fortunately, I have had little residual once recovery from the TUMT or PVP was underway. Beyond that I have no experience with self cath. > Nelson, Ed, Chockman and others, > [quoted text clipped - 66 lines] >>I am currently awaiting the results of second PSA test so this might >>all be academic for me anyway :-( >At what point to you guys self cath. Is it based on a time schedule - >obviously not in Ed's case, since he does it once or twice a year, or do you >cath when you feel a strong urge or discomfort, or do you use the "press on >your belly test" to see how bad it feels. I have used the so called press >on the belly test ever since I was a kid, but it may not be a good indicator >for some people, that's why I am asking. I self-cath only when I am in acute retention. This happens only when my bladder is over-full. This used to happen under unusual circumstances, like when they asked me to drink 4 full glasses of water for a biopsy... or during travel when I had no time to pee before catching a connecting flight. Now it never happens during the day, because I can foresee dangerous situations. Now it happens only at night, because once or twice a year I wake up over-full. >Let me ask in relation to this, can some people have their bladder fill up >but be oblivious to the pain or discomfort which is the body's normal >warning system that it is time to go... Yes, when I'm asleep. But some guys have chronic retention. They walk around with 1000 cc or more of urine apparently without realizing it. Ed >> At what point to you guys self cath. Is it based on a time schedule >> - obviously not in Ed's case, since he does it once or twice a year, [quoted text clipped - 20 lines] > But some guys have chronic retention. They walk around with 1000 cc or > more of urine apparently without realizing it. Thanks Ed...that is interesting. Dr. Sancha, if you read this please comment...Pete > Ed [snip] > At what point to you guys self cath. I'd have to say "whenever I feel the need" :-) Before seeing my wife's experience, I thought it was a BIG DEAL. It is certainly made to sound such by the medical community and it sounds frightening. I frequently have to help my wife because women can't see where to stick it like we can. Then again, they don't have to shove it in so far... just a couple of inches. I'm sure this is more information than you care to know, but after seeing her do it multiple times a day I said "how hard can it be"? (I should mention that I have also had to start IV's for her and give her injections, so I'm not squeamish) One night after a DRE, I couldn't start. It scared me. So I decided to learn how to do it. My symptoms wax and wain with no apparent pattern. When they are bad, I'll cath. When they are not, I don't. If I find I am getting up too many times a night, a good cath empties it out and I can usually sleep the rest of the night. From observation, I seem to retain 200 - 400 cc. My guess is that my personal "time to pee" alarm bell goes off at around 500 - 600 cc. That means I am voiding around 100 - 200 cc at a time and it doesn't take long to hit that mark during the night. Cathing usually allows me to sleep through the night. In the day time the frequency is a hassle but not worth cathing. There also seems to be some phenomenon where sleeping makes the muscle not as strong temporarily... probably part of the same paralysis chemical that keeps you from sleepwalking while you are dreaming, so it is often harder to start at night and the stream isn't as strong. And it seems I retain more at night than during the day as a result. Another poster in this thread implies that this will lead to open prostectomy surgery. Seems to me that's an unwarranted generalization from a data point of one. As I understand it the dangers of BPH are primarily due to retention with it's associated backup into the kidneys and infection and stone formation from concentration in the bladder. Self cathing prevents this. Some might say they prefer butchery to self cath and I can understand that. But for those of us who value the continued use of their penis, I don't see why self cath can't be a viable alternative... at least for a while. At least knowing how gives you a measure of control over your own fate and a sense of security that you will be able to handle situations that would otherwise be awkward or require a trip to the hospital. I am very glad I learned how to do it and view it as just another of the available tools to deal with this problem. And of all the tools, I would submit it has the least risk and/or side effects... not to mention being the least expensive :-) SignatureNelson Thanks Nelson...see my inline comments...Pete > [snip] > [quoted text clipped - 8 lines] > shove it in so far... just a couple of inches. I'm sure this is more > information than you care to know, Not at all Nelson...I appreciate all your info herein. Who "taught" your wife to do her cathing when she first started (was it a uro), and who does she visit for her MS (i.e. a specialist or just her primary care physician). My heart goes out to her...Pete but after seeing her do it multiple > times a day I said "how hard can it be"? (I should mention that I > have also had to start IV's for her and give her injections, so I'm [quoted text clipped - 9 lines] > > From observation, I seem to retain 200 - 400 cc. Nelson...I guess you tell by voiding and then measuring the amount you get from the catheter in a cup afterward (I use a 9 ounce paper cup and my watch to check my uroflow in the day - but like I said I can't hardly pee at all later in the day and at night). It looks like you just joined our ng based on a quick search - have you had an ultrasound lately to check your retention (but the catheter method should be more accurate for sure). I was thinking about buying a portable ultrasound for peace of mind, but the damn things are way too expensive...Pete My guess is that my > personal "time to pee" alarm bell goes off at around 500 - 600 cc. > That means I am voiding around 100 - 200 cc at a time and it doesn't > take long to hit that mark during the night. Cathing usually allows > me to sleep through the night. Does this mean you cath almost every night, before going to bed, to get the 200-400cc out (that you think you are retaining). Also if you didn't get it out (say once a day), I would think that could cause a bladder infection, since that amount shouldn't cause backup to the kidneys. What does your uro say about having residual urine in your bladder all the time. May I ask how old you are and how long have you been doing the self cathing...Pete In the day time the frequency is a > hassle but not worth cathing. There also seems to be some phenomenon > where sleeping makes the muscle not as strong temporarily... probably [quoted text clipped - 21 lines] > I would submit it has the least risk and/or side effects... not to > mention being the least expensive :-) [snip] > Who "taught" your wife to do her cathing when she first started (was > it a uro), and who does she visit for her MS (i.e. a specialist or > just her primary care physician). "Taught" is really an overstatement... with a woman, you just stick it in. With a man, you have to worry about going around the bend. But in either case if you can put a round peg in a round hole, you pretty much have the idea :-) I think it was a Nurse at the uro's office who showed her how to do it. The problem for a woman, as I said, is they have to do it by feel and if she misses she contaminates the catheter and has to use another. The other trick is not to push it too far past the bladder opening and to make sure the external tube doesn't arc up higher than the bladder... basic hydrodynamics. Other than that, the emphasis is on hygiene to avoid infections. Pretty obvious stuff. We wash the catheter in disinfectant soap both before and after and use a syringe to clean out the internal part. She used to get infections when she did it herself because of the misses... it's difficult for a healthy woman much less one with MS. Now I just poke it in for her it and she hasn't had an infection in ages. She sees an MS Specialist about once every six months but it's pretty much a way for the Specialist to make boat payments. They really don't know Jack about MS or what to do about it other than to say "Hmm". > but after seeing her do it multiple >> times a day I said "how hard can it be"? (I should mention that I [quoted text clipped - 19 lines] > thinking about buying a portable ultrasound for peace of mind, but the damn > things are way too expensive...Pete I bought a couple of nice urine bottles at Wal-Mart for about $2 each. I carry one in the car for emergencies and I use the one at home to measure. I can't imagine why one would use ultrasound to measure retention when cathing is so easy. > My guess is that my >> personal "time to pee" alarm bell goes off at around 500 - 600 cc. [quoted text clipped - 4 lines] > Does this mean you cath almost every night, before going to bed, to get the > 200-400cc out (that you think you are retaining). If I cath, I _know_ what I am retaining. As I said, I don't cath every night. I only do it if I am getting up too frequently to pee on a given night. I keep the urine bottle next to the bed to avoid the trip to the bathroom. Most nights it's no big deal. In another age they used to call it a chamber pot and empty it out the window in the morning :-) > Also if you didn't get it out (say once a day), I would think that > could cause a bladder infection, since that amount shouldn't cause > backup to the kidneys. Who knows? It's always being diluted with new stuff and if I notice it getting dark, I push more water. I have had maybe one bladder infection in the last 5 years and it was pretty easy to clear up. > What does your uro say about having residual urine in your bladder > all the time. Of course, he wants to do surgery. Look, urology is a _surgical_ specialty. To a hammer everything looks like a nail. The guy I saw 10 years ago wanted to do surgery... I'm glad I waited. In the interim, PVP was developed. I think it is still a bad option but it is less bad than the others :-) Who knows, if I can cath it out a few more years something else might come along. Or my PSA test might make the whole thing moot. > May I ask how > old you are and how long have you been doing the self cathing I'm 61 and have been self-cathing for about a year off and on. I have had BPH symptoms since my late 40's. SignatureNelson Thanks Nelson...One more question - what is the specialty called for MS (as in gastroenterology and otolaryngology, etc), or is it a just a neurologist..Pete > Thanks Nelson...One more question - what is the specialty called for MS (as > in gastroenterology and otolaryngology, etc), or is it a just a > neurologist..Pete The latter. SignatureNelson >I bought a couple of nice urine bottles at Wal-Mart for about $2 each. >I carry one in the car for emergencies and I use the one at home to >measure. I can't imagine why one would use ultrasound to measure >retention when cathing is so easy. Urine bottles at Wal-Mart?? In what department? Are they graduated in cc? > Or my PSA test might make the whole >thing moot. Why? My PSA was 26 last year... Ed >> I bought a couple of nice urine bottles at Wal-Mart for about $2 each. >> I carry one in the car for emergencies and I use the one at home to [quoted text clipped - 3 lines] > Urine bottles at Wal-Mart?? In what department? Are they graduated in > cc? In the pharmacy by the home health care needs. They are graduated in cc's and oz. Same size and shape as the ones in the hospital. SignatureNelson Dear All, what a long thread!!! Self cath is mainly used by people with paralyzed bladders for different reasons, they use this for a lifetime and they use to do relatively well. The risks of self-cath are relatively small and the main concern is kidney function, because if they do not catheterise frequently enough they might develop back pressure into the kidneys and lose kidney function. To my knowledge nobody has compared the risks of surgery to the risks of lifetime catheterisation, but in my mind self-cath for all your life is worse than surgery, specially when the risk of new operations is smaller than open prostate surgery or TURP. If you self cath, make sure you do it frequently enough. If you self cath after voiding and the residual is high (e.g. 400), you need to catheterise frequently, and also keep an eye in your renal function. The amount of people walking around with high residuals without noticing it is higher than you would think, they usually present with symptoms of renal insuficiency and chronic retention of urine, their creatinine rises up to 9 or 10 (normal value is 1), and when they are catheterised they recover part of their renal function, but sometimes they are left with residual renal insuficiency. I have seen patients with three litre bladders and it takes very long for them to recover normal voiding even after prostatectomy. Regards, Fernando Gómez Sancha http://drgomezsancha.blogspot.com [snip] > To my knowledge nobody has compared the risks of surgery to the risks of > lifetime catheterisation, but in my mind self-cath for all your life is worse > than surgery, specially when the risk of new operations is smaller than open > prostate surgery or TURP. Dr. Sancha, Respectfully, I don't think those are the only two options. I would submit that self-cath could be used, for example, to defer surgery for a younger man who has the most to lose from the still very likely side effects of surgery or the common undesirable side effects of drugs. Of course the situation would have to be monitored and it is certainly not an option for everyone but it is not an option that I have ever seen discussed much less studied. In my own case the results of multiple DREs are clasified as "normal" with regard to prostate size, so I am not facing some sort of runaway growth. I have also been told by my urologist (whom I selected because he has done many PVP's) that the likelihood of retrograde ejaculation from PVP is >80%, that more frequently than not there is a painful recovery period, and that it is likely that the operation will have to be repeated. So I'm thinking that maybe another 5 years on the learning curve will have improved the technique enough to get those odds down or a new treatment may have emerged. In the meantime, I haven't done anything irreversible but have had to put up with some inconvenience. To me, at least, it sounds like a good trade-off :-) SignatureNelson [snip] > Plus, I can now deal myself with certain potentially very awkward > situations (hypothetical for now) like experiencing retention in the > middle of a 9-hour intercontinental flight, or in the bush hours away > from help, or just before an important business appointment. Amen > Note, if you are contemplating trying this -- there is a risk of > infection and other risks - know what you are doing, and get the > cooperation of your doctor first -- you bear all the responsibility > yourself. You always bear all the responsibility. > Ben Franklin's reed might have been painful, or not. He would probably > have used butter with it, and it would be much preferred to the > alternative, which was suffered by Thomas Jefferson. > > Ed I was thinking about going around the corner with it. Guess it depends on the reed :-) SignatureNelson |
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