Acute urinary retention.... Need advice on options please.

Hi Ali, 

My profile is much like your husbands...I am 63 and was peeing slowly the last few years, but never a problem with complete retention.  Then one day in Feb. all of a sudden, I could not pee!  I am very healthy, never had health issues before. Went to ER, got catheterized and tested and told I had a 136cm  enlarged prostate.  No signs overtly of cancer, but high PSA of 7.  So after some research , I elected for gettting a PAE surgery at UNC by Dr. Issacson.  I am three months out from that I feel great, no side effects, peeing stronger than  before surgery!  Only slight issue is that when I have orgasm, not very much semen comes out, but orgasm still is great.   So, hope that helps. Definietly PAE is worth considering if its an enlarged prostate. especially if it is very large, this works great on it!

Greg

All: Rest easy as urine retention due to an enlarged prostate can be the result of infection, BPH, calcification (stones) in the wrong place in the bladder neck and so on. Please don't jump to concerns about prostate cancer (PCa) unless your urologist has established this is the case following tests. The urologist will want PSA results from a blood test, a digital rectal examination (DRE),and may recommend other tests.

Don't let him be subjected to a biopsy unless it is guided by having a MRI first, finances permitting. I am sure that at 54 years of age, he will be fine.

Hi Alil!

The gentlest of kicks in your bum here: your husband's situation (statistically) does NOT likely have anything to do with the dreaded C word!  It much more likely has to do with a simple physical phenomenon:  that damned little bugger (the prostate) just keeps on growing, puts the squeeze on the urethra until it is unable to pass urine at all.  

Your husband is likely experiencing the shock of his situation; we have all been where he is now, and we have adjusted to the "new normal," as can he (and can you!)

No, I'm not a doctor (I'm an artist!).  That said, overactive prostates can be dealt with many ways these days, from the "standard" TURP that his doctor will likely push him to accept, to the "green light surgery," the  Urolift,  PAE and a few other options that others will hopefully describe to you.  We all have our favorite remedies to recommend.  I favor the Urolift, which is the only reversible procedure, but not all men can have it.  I STRONGLY urge your husband to NOT accept TURP without researching his options, as it can severely affect and limit his personal and your joint quality-of-life.

Also, wearing that bag is a hideous experience, and for me was very disorienting.  I went from that to CIC (intermittant cathetertizing) after one week,  refused the TURP my urologist wanted to do to me, and cathed every time I needed to pee.  This went on for 15 months until I had the Urolift surgery.  It became second nature and my wife was quite supportive.  I highly recommend this approach, as will others who refused the TURP.  Best brand in my experience:  SpeediCath.  Second best: Magic 3, based on ease of use/simplicity.

We are happy to offer support and answer your husband's questions, down to the most delicate ones!  :-) 

If he's not too shy about it, get him on-line; we've all been where he is now!

Hi Ali,

Sorry about the scare you are going through. 

First, none of us are doctors here so please keep that in mind with the answers you will be getting. 

It's understandable that you are thinking cancer, but in all probability, given your husband's age and history, it's probably bph. 

You are on the right track being looking for different options as opposed to simply surgery. That said, it it is bph, be prepared for the urologist to recommend surgery. Here in the States the most common recommendation is TURP or GreenLight. In both cases your husband would end up with something called retrograde ejaculation also known as a dry orgasm. This doesn't bother some men, but it does bother others. Having children in the future could also be a concern.

As for alternatives, there are some newer less invasive options now available that will not result in retrograde ejaculation. Even better ones hopefully on the horizon. 

Meanwhile, there are some drugs such as Tamsulosin (Flomax) and Daily Cialias that help some men with BPH. These are often tried before surgery is offered. Also, there's self catherization (CIC) that can manage BPH symptons quite well as a temporary solution or even as a long term one. I personally have been self catherizing for almost three years now because I did not like any of the surgical alternatives being offered.

As to saw palmetto, pumpkin oil, etc, some people take them, some don't, but I don't think you should expect the kind of results being advertised online if he truly has an obstruction causing bph. 

Jim

Tell your husband not to panic. I've had similar problems since I was 45, I'm now 64. Over the years have had 5 to 6 biopsies because of an elevated PSA of 20. All the biopsies have been negative. One of my urologists said I have a "state fair" size prostate. 1st I tried all the over the counter therapies, none of that worked for me. Now I'm on Flomax and Finasteride. Up to this point it has helped, but was never able to void like a young man. I would say 5 years ago I had my 1st catheter put in. I recovered from that and my urologist increased my meds, I was able to void again until this point. Digressing a bit I had the Green Light procedure, for me it was an absolute waist of time and money. Subsequent urologist agreed with me, they never use that procedure. Now in a short time period since January Ist, I have had 3 catheters in, trying to avoid a TURIP procedure. My body has told me it's time to do something, for me it seems it's Turip. I reascearched urolift and other new procedures, for me and my urologist we feel

those procedures are to new to have an established track record. So on the 24th of May I'm scheduled to have a turip. Hope this was of some help? Denis

Just want to add you and your husband should not be scared or bullied by a doctor for a quick decision. This sometimes happens if acute retention remains a concern. Or, as "Cartoonman" said, don't let them send him home with a Foley Catheter and a a bag unless it's very short term such as under two weeks. If longer, ask/demand that he be instructed in self catherization (CIC) which will let him empty his bladder whenever he wants while giving him freedom of movement. And, as previously stated, it should also clear up all his bph symptons buying him time so he's not rushed into a decision.

Jim

PSA test is a simple blood test and of itself not very reliable unless unusually high. One has to watch how the readings change over a few months for that test to be useful.  There are certain drugs, two in particular, finasteride and tamulosin are known to actually 'do something', but typically take a few weeks to show any improvements. Alternatives from the saw palmetto onwards have never had any rigorous proof of effectiveness, although some men think they do.

As others have already said, it is best not to allow him to be bumped into any operation until more is known, but my advice would be to get him taught how to self-catheterise with a supply of catheters. Sudden acute retention is a horribly agonising experience. In parts of the world where prostate operations are a source of lots of revenue, you will get strong resistance from urinary consultants to learning catheterisation, because catherisation allows an almost indefinte delay in making a operation decision, which is great for a patient, terrible for a surgeon !! 

In the UK this is well recognised, and doing CIC as it is called (clean intermittent catheterisation) is often looked on perfectly sympathetically.

At 54, he needs to be very wary of procedures virtually guaranteed to cause fairly major sexual changes (and that includes the two medicines I mentioned sadly).

In summary, after the absolute trauma he has just been through (retention), it is difficult to accept that in reality, provided he has the means to empty his bladder easily at any time, there is rarely any need for 'instant action' so to speak. Hope this helps.

I second . They may not be doctors butn they have Experience and know what theyare talking about!

Alan

 

Hi Ali,

Don't panic!

I had acute urine retention in my 50s following general anaesthetic. Peed OK at first and was allowed home, but during the journey, my bladder got more and more full and overnight kept trying to pee but only managed a few dribbles. A & E (UK) sorted me out with in-dwelling foley catheter, leg bag and prescription for Tamsulosin, which the doc said I'd have to be on for life. In fact both catheter and Medication were not required after a few weeks, and all was normal for a couple of years. Even now, at nearly 66, although I have had catheters both in-dwelling and intermittent, I only had trouble voiding last year because of infections, which have finally cleared with 3 months on Nitrofurantoin. One urologist scheduled me for TURP, but on the day the consultant decided to wait, as the infections had cleared and my prostate is not greatly enlarged. Instead, I'm back on the Tamsulosin and I've been asked to try cutting out all tea and coffee, for up to a year. Others have mentioned that drugs like Tamsulosin cause semen to go back into the bladder rather than out at orgasm, so if you want more children, your husbands choices might nedd to be taken with extra care. Best of luck to both of you, and remember, even Prostate Cancer is not as scary as it used to be. I've had minimal cancer diagnosed and results of psa scores around 8 for many years without treatment needed.

I'm 61 and had a similar experience at 57. After some flow issues, one day I woke up and couldn't pee. After three miserable days with a foley cath, I was put on meds (alfusozin - not retro ejaculation) saw palmetto and did some PT. I was able to manage and only had to self cath once in 3/12 years. At the time, there was no proocudure that didn't come with too many risks and side effeccts to consider.

DO NOT let him consent to a TURP at 54 with only one child. It's last century's surgery, often causes real problems and will ensure that you'll never have another child. There are many that are less invasive - PAE is one (Urologists don't recommend it because its performed by Internevtional radiologists) and Rezum is another. Both use different methods to kill part of the prostate and the dead tissue is absorbed over time by the body - leaving a smaller functioning prostate and no real side effects. Both are performed without anesthesia. Urolift sort of staples down the prostate, opening up the flow - also non invasive with no side effects.

Its unlikely that your husband has cancer, as it grows progressivley and typically doesn't cause you to wake up one day unable to pee wihtout porgressive warning. From your vervbiage, it sounds like you're from the UK. Not sure what's avaiable there, how long it takes to be approved, etc. But I would avoid TURP at all costs, lokk into the less invasive options - if none are available, I wouldrecommend considering self cathing til they are, or if you can afford it, pay out of pocket for Urolift, PAE or Rezum, before opting for any surgery.

Hi AliL,

From my experience he should learn CIC ASAP and use speedicath or speedicath compact male catheters (maybe mix depending on whether at home or not).  Also, Alfuzosin has the best side effect profile of the alpha-blocker drugs.  Might be best to try it first.

If he opts for a procedure, PAE might be the best way to go w/ minimal side effects (esp. sexual).  The 2 docs who have done the most in the US are Dr. Ari Isaacson  at UNC Healthcare and  Dr. Bagla in VA.  Good luck!

your husband had an acute urine detention ,but before of that has he had a great drinking ?i have had two times but only becausse i drunk mouch water( the second time the eografist told me drink one liter water for better ecography,,,,,,,,