After release from hospital I engaged urologist number 4.  We continued
antibiotics for a week or so, along with a Foley catheter.  But, unlike
earlier episodes, I was still unable to pass any urine at all.  Clearly it
was time for more aggressive treatment.

Uro 4 took me through the available options, including microwave, etc (there
is a complete rundown on these at the Mayo Clinic site, including scary
experimental procedures).  I interrupted him part way through saying
"Doctor, I'm biased toward PVP or other laser."  He said frankly, "So am
I.", and that pretty well settled it; I was very glad we had similar
opinions.  Surgery was scheduled for nearly two weeks (September 10) later
in order to be sure the infection was under control.  I went home with a
Foley catheter again, and we hoped I would be able to remove it a few days
before the surgery.

Removal of a Foley is really simple; here is how I did it (anyone trying it
should get instruction and approval from their doctor, as I did).  The Foley
is held in place by a small balloon on the bladder end of the catheter,
which is inflated, using a syringe, with 10 cc of WATER,  (NOT AIR which is
likely to leak out), after the catheter has been fully inserted into the
bladder.  To remove the catheter, one needs only a pair of scissors.  At the
lower end the Foley branches into two channels; main channel from the
bladder, and another smaller branch channel, connected to the balloon, with
a hard plastic collar around it.  When the smaller channel is cut with
scissors, the water will drain out from pressure in the balloon.  When the
water is completely drained, the catheter can be gently pulled out.
Actually, professionals use a syringe to completely evacuate the water;
balloon compression in the urethra may produce a small amount of additional
water with the scissors method.

I was still unable to pass urine, but I was set up to self-catheterize,
which I did.  I will not attempt directions for self-catheterization, though
it is quite simple, because there are some risks, and it needs to be
demonstrated by your doctor or his staff.  Here is one clue I would like to
share however.  During my weekend ordeal described in an earlier message, I
attempted self-cath, and failed.  This led to some erroneous conclusions
about my condition.  Failed almost certainly because the catheter was
stopped up by a bit of the K-Y lubricant.  The solution here is to take a
gentle suction on the catheter with a syringe.  This will pull out the
stoppage and start the flow of urine.  In my experience this happens about
one time out of four or five.  If no syringe is available it would probably
be necessary to withdraw the cath and start over.  Catheters come in 'FR'
sizes, FR-12 to FR-18 are the sizes I have seen.  I believe each three FR
units equal one millimeter, thus FR-12 would measure four millimeters.  In
the event however, I found self-cath every six hours or so for five days to
be too confining and aggravating, and so elected to have the Foley in place
until surgery time.

My prostate was only slightly enlarged to 33 grams, but the enlargement was
situated such that it had permanently compressed the urethra channel so as
to cause acute urinary retention.  He also said most of the infection is
generally in the first millimeter or two of the urethral surface, and is
burned away by the laser

My PVP surgery occurred on September 10, at the Urology Center of Colorado,
in Denver under quick-acting and quick-release general anesthesia.  It went
smoothly, and I am grateful to my urologist and anesthetist and the staff.
Everyone in the operating room was either an MD or an RN; I was reassured by
this, and would insist on it, had I to do it over.  The green light PVP
laser, my uro says, removed about 60% of my prostate and this is normal for
my situation.  (A TURP removes more, 80%+, new post-green light lasers take
less than the green light.)  The channel cut through my prostate is about 8
mm (compare with a 9 mm bullet).

As of this weekiversary I am doing fine, some small bleeding and some
bladder spasms at conclusion of voiding, but that is diminishing.  Uro says
no sex for six weeks and that is chapping me, but I'm not disposed to defy
him, so I guess we'll just have to get through it.  So I am eighteen grams
lighter, resting a lot, and feeling better each day.

Best of luck to you brothers out there who are sharing this experience, I
hope this will be helpful. (I understand 80% of us who live to make old
bones will deal with this in one form or another.)

As Ever

Charles

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