Acupuncture for Urinary Retention

Fred, thanks for your response and happy to hear the REZUM worked for you. May I ask if you were peeing on your own before the procedure? My problem is my "massively distended bladder" discovered during a recent CT scan after a spill from my bike. The uro says although my urinary retention is due to BPH, over 5 litres were drained during a recent ER visit so my bladder is flabby and the muscles won't squeeze.

Bottom line, no use in opening the pipe unless the pump is working. He said my chance at peeing after a procedure are at 20-30%...so I'll keep with the CIC and hoping for an outcome like Jim's.

Patrick, I also have a distended bladder, neurogenic bladder. I was retaining 1.5 liters of urine before I started CIC. I thought that was a lot, but nowhere near your 5 liters. I have been performing CIC for over two years. I don't know if my bladder will shrink back up, but I do get the occasional urge to urinate. So far I have been unsuccessful in voiding naturally. However, CIC is now second nature, and I am pretty much on a schedule for voiding with a catheter.

Thanks for your reply. Yes, holding over 5 liters makes for a flabby bladder after it's emptied...and I'm not sure how much I can expect it to shrink but am hopeful CIC will help. Has your uro given you any options other than CIC? Mine has said my bladder is not neurogenic but atonic and the muscles won't squeeze the urine out. Before my bike spill and trip to the ER where my distended bladder was diagnosed, I was urinating regularly but was advised by the urology staff this was due to the pressure from 5 liters in the bladder and once this was removed by the ER Foley, I haven't voided naturally since.

Hoping this will change but getting habituated to the CIC routine.

Best to you going forward!

Patrick

Patrick,

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If they took 5 liters of pee out of you, then your bladder was very badly distended and most like damaged too. Acupuncture and other new age nonsense isn't going to do squat for your bladder.

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You need a urodynamics test to determine the condition of your detrusor muscle and a cystoscopy to determine condition of your bladder wall. Both of these will determine the bladder damage.

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Have you had both of these yet?

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BPH results in bladder outlet obstruction (BOO). BOO results in bladder damage. If your bladder is damaged (which 5 liters or retention will do), removing the obstruction from BPH may or may not help.

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In January 2018, I had 2 liters of pee removed and a Foley put in for a month. After the Foley was removed, I could not pee on my own. It took 3 more months to get any sensation to pee.

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At 6 months, I failed my urodynamics test and at 10 months, my cystoscopy showed moderate bladder damage (trabeculation). After 10 months of self-cathing, I decided to try a Rezum .

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My BPH obstruction was cleared by a successful Rezum and I can pee again. After the Rezum, it took 9 months for my bladder to recover to where my PVR's were under 100 ml which is OK for guys our age.

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As you wrote "Bottom line, no use in opening the pipe unless the pump is working". Good luck to you on bladder recovery. Rezum will be the least invasive procedure available today. Maybe it will work for you.

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Steve

Patrick,

I could not pee at all for 3 years. My prostate had been getting bigger and bigger until it hit 93 grams with a median lobe and I ended up in the ER with acute urinary retention and they put in a Foley which I kept for about a week. I think the 3 years of CIC rehabilitated my bladder somewhat. I can pee pretty well right now and rarely have to use a catheter. Glad I had the REZUM procedure .

Hey Steve,

Appreciate your reply. Yes, I had both the urodynamics testing (which I failed) and the cystoscopy. My uro only said "the muscles are not squeezing" but did not elaborate further than say any procedure at this point would only be 20-30% successful in allowing me to urinate without a catheter. Considering those odds, I chose to defer any procedure and give the CIC more time to maybe rehab and recover my bladder function. I know it's a long shot at this point, but worth a chance considering the alternative of opting for a surgical procedure which is likely to not help and then live with any negative side effects.

Thanks for the suggestion of Rezum which I will discuss with my uro next visit. For now I will live with the minor inconvenience of CIC therapy which buys me time and hopefully helps rehab my bladder.

Curious if you are still doing CIC after your Rezum or if you are urinating on your own 100%. Were you self-cathing during those 9 months following Rezum?

Patrick

Light,

Thanks for your reply. Happy to hear the Rezum worked for you. At what point did you opt for the Rezum...before, during or after the 3 years of CIC?

Patrick

Patrick,

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I recommend that you get a 2nd opinion from a 2nd urologist and research the 2nd urologist very carefully before seeing them. That was the best thing that I ever did for my BPH. Getting a 2nd opinion is a common suggestion on these forums. The 1st urologist that I saw was basically a dead end.

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The 1st urologist said that my urodynamics test showed that my detrusor muscle could not squeeze and all hope was lost for me and surgery would do nothing. After carefully researching another urologist my urodynamics test was reevaluated and showed that my detrusor muscle was squeezing but struggling.

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About a month later, I had a Rezum and a month after that, I started to pee again as it takes about a month to open up after a Rezum. Because my bladder was damaged, recovery has been slow but my bladder is recovering. I self-cath only to measure my PVR's which I record and graph in Excel. I don't need to do it though.

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I had 2 liters of pee removed and you had 5, so your bladder was probably more damaged than mine.

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Steve

Patrick,

I did 3 years of CIC beginning in August of 2016 after going to the ER in acute urinary retention (only 800ml but caused plenty of discomfort!) and getting a Foley for a week or so. In June of 2019 I had the REZUM procedure. I'm not sure but I'm assuming the 3 years of CIC rehabilitated my bladder somewhat. I'm in fairly decent shape now and rarely have to CIC.

Fred

Fred,

Thanks for your response. So you had the Rezum after 3 years of CIC. May I ask what made you decide to go with the Rezum? Did your uro recommend it? Were you advised it may eliminate the need to continue CIC?

Just curious at what point does one decide to go to a procedure after CIC.

Patrick

Steve,

Thanks for your response.

I am not in a hurry to rush into a procedure so I will continue CIC in hopes of rehabbing my bladder and continue discussions with my current uro about what happens next. He seems to agree that continuing CIC is my best option at this point but we have not eliminated the possibility of a procedure going forward.

As the nurse who did the urodynamics test advised, I did not get here overnight and the recovery will not be fast.

Patrick

Patrick,

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Self-cathing for a period of time to rehab the bladder is standard procedure. I did it for 10 months. If you were holding 5 liters of pee, then as you said "I did not get here overnight and the recovery will not be fast". I was holding 2 liters and I was told the same thing so I agree.

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After failing my urodynamics test at 6 months, the idea was to self-cath for another 6 months and then do another urodynamics test before considering surgery and this urologist only did old mono TURP. This gave me lots of time to research the various options available and other urologists too.

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I worked closely with a family member that I have known for over 60 who was an MD for over 40 years and we looked at the various options available and chose Rezum as a 1st attempt because it had the least morbidity and complications. If it did not work, then I could try a more invasive procedure later. Fortunately Rezum worked for me.

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The 1st urologist who only did old mono TURP was against Rezum and advocated for what he did. This is unfortunately common with doctors. With the guidance of the family-member-MD I asked some very specific questions on morbidity and complications and he avoided answering them so I decided to move on.

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With any BPH procedure (some more and some less), there is always the possibility that you fix one thing and break another which I would prefer to not have broken...

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Steve

Steve,

Thanks for your informative and helpful reply. I expect to have another urodynamics test at some point in the future but am unsure what signs to look for to let me know a procedure is warranted. How did you know it was time to go for the Rezum procedure?

My uro does HoLep but hasn't recommended it for me as of yet. At this point I would be more likely to consider a less invasive procedure like Rezum. I would be interested in any feedback from those who have had the HoLep procedure done.

Patrick

As well as those who considered HoLep but decided against it and why.

My urologist has discussed surgical options, but at this point he is not recommending anything. I believe partly because my bladder hasn't rehabbed enough in two plus years of CIC for me to void naturally and partly because I am doing well with CIC. Also, I don't leak now, and there is no guarantee that surgery won't make things worse.

Patrick,

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HoLEP will have the same complications are TURP but with less morbidity (bleeding) because it is a resection technique that cuts tissue with a laser which "seals as it slices" unlike TURP which cuts with a wire loop.

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HoLEP has been around for a while, but fell out in favor of GLEP (Greenlight Laser Enucleation of the Prostate) which vaporizes tissue with a laser instead. HoLEP appears to be having a comeback recently.

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Several factors came together for me to know that it was time for my Rezum that are listed chronologically as follows:

1. Over 10 months of self-cathing, I had the time necessary to do my research on the various BPH procedures available to me and I chose Rezum.
2. Over that same time, I had seen 3 different urologists and based on a recommendation from this forum, I found the urologist to do my Rezum.
3. After 3 months of catheters, the sensation to pee came back. By 5 months, a strong sensations to pee came back. By 8 months, regulating my flow when self-cathing came back. My bladder was obliviously improving even though I could not pee.
4. At 10 months, I consulted with the urologist that did my Rezum who reviewed my BPH medical history and urodynamics tests and decided on the next step which was a cystoscopy.
5. At 10 1/2 months, I had a cystoscopy which identified the type of BPH obstruction, the extent of bladder damage (trabeculation) and measurements required for the Rezum.
6. At 11 months, I had my Rezum which then followed the standard recovery schedule over the next 3 months.

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   So knowing that it was time for my Rezum was a progression over several months. Also after 10 months of self-cathing 4 times a day was starting to get old. ** Self-cathing is necessary skill to know though for any guy who decides on Rezum!**

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   Good luck to you,

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   Steve

Sounds familiar, but I am only a month into CIC. I will learn about patience being a virtue. Thanks for sharing your experience!

Patrick

Steve,

Thanks for your most informative history of your path.

Regarding your last sentence:

** Self-cathing is necessary skill to know though for any guy who decides on Rezum!**

Does that mean you are still self-cathing after Rezum? You said earlier that you do it only to measure PVRs, but am curious how often you use it. Sounds like Rezum was successful for you since you now void naturally without a catheter. So what is your average PVR now? And do you cath after every natural void?

Patrick

Patrick,

I tried every potion and natural/holistic remedy to no avail. I could not pee at all and was using 6 catheters a day. It was limiting my lifestyle and making me feel really old. I had done a lot of research, reading on this forum and calling/writing members who had undergone various procedures. I visited and/or called a lot of different urologists and radiologists who specialized in various procedures, urolift, PAE, HOLEP, TURP, FLA, REZUM, etc. and read up on other procedures like aquablation, greenlight, and so forth. I narrowed it down to FLA and REZUM. I talked with Dr. K a number of times and with people who had FLA. Dr. K told me because I had a lesion near one of the nerve bundles, I might end up impotent so I crossed that off. REZUM seemed to carry the least risk. I figured I could always do another procedure later if it didn't work. Fortunately it did work. 13 steam injections done under "twilight" anesthesia. Everyone has to do his own research and make his own decisions. Good luck with yours. Feel free to contact me for any additional information you need.

Good luck going forward. All I can say is CIC changed my life for the better. Before I started, I was getting up several times a night to urinate. During the day, I might urinate several times in an hour. I could take up to two minutes for the flow to start and to dribble out about a half urine sample cup of urine. When the urge did come on, I needed to find a bathroom quickly. At the time, I was unaware of the retainage. That is all in the past. Since you are new to CIC, I recommend that you try different brands, sizes and styles of catheters. I injured myself the first couple of times I tried CIC. I was using stiff plastic coude tip catheters that my uro gave me. He switched me to straight tip, latex catheters, which are more flexible. I have had no bleeding or other problems since. I now use a combination of straight tip, latex and soft plastic catheters.

Hi, PlufF_Mud,

I second your comments entirely. The only bleeders I've had happened when I was evaluating a catheter new to me, and even then not every time.

My problem is catheter length; this approach that "one size fits all" -- lengthwise, not diameter -- is crazy in my view. However, the Powers-that-Be have responded positively. The instructions for inserting a Foley or other indwelling catheter used to read, "...when you see urine flow it is safe to inflate the retention balloon." now reads, "... insert catheter up to the 'Y' before inflating the retention balloon." My ruptured prostate may well have contributed, with others, to this change. Hence the importance of speaking up!

I had found a pair of catheters that were 17 inches long, and what a difference even 1 inch can make. But, Alas! The self-lubricant they used irritated me badly and caused bleeding, so I had to abandon them.

BTW, I C.I.C. three times a day using a soft, clear plastic, 16 Fr. straight pre-lubed catheter.

All the best, alan86734.

Thanks for your reply. My CIC nurse left me several different brands and types samples in addition to the straight tip FR 14 SpeediCath prescribed by my uro, but I have found the SpeediCath to be my "go to" cath.

As far as "bleeders" , I had minimal bleeding and clots my first few caths but none since and the process is virtually painless if a bit uncomfortable. I also got some samples of the SpeediCath compact which is very easy to use and very discrete as you can carry it in your pocket as it telescopes when opened. Only problem is, it costs about $6 each and is not covered by insurance so out of pocket for most of us unless your uro prescribes it. As I understand it, you have to have a history of UTIs to get a prescription as it is a "sterile kit".

Best to all,

Patrick

Thanks for your response. So 13 steam injections...does that mean 13 separate procedures or was this done in one procedure while you were "twilighted"?

I would like more info on Rezum as this seems the less intrusive with minimal side effects.

Patrick

Isn't the SpeediCath hydrophilic? If they are the ones I am thinking of, they are rather stiff. I have used some of the non-lubricated Coloplast catheters. They make two versions, and one is softer and more flexible than the other, which is the one I prefer. Yes, it is my understanding that you need to have a history of UTIs to get a script for the hydrophilic catheters, which includes the compact versions. Medicare and Tricare cover the full cost of my non lubricated catheters, plus lube. I could always pay extra out of pocket if I wanted the hydrophilic ones. I do purchase some of those compact ones to carry when traveling. They are convenient, but expensive.

Yes, my SpeediCaths are hydrophilic and covered my my Medicare, and I have no history of UTIs (knock on wood), but my understanding is you DO need a history of UTIs to get a prescription for the compacts which are a "sterile kit" and covered by Medicare IF you qualify. Since I don't have a history of UTIs, I will pay out of pocket for the convenience of the compacts for travel and being out and about. I would use these 100% if they were covered and not out of pocket.

Can we lobby somewhere to get this changed?

Patrick

Patrick,

The Rezum procedure allows the physician to administer between 1 and 15 steam injections . There is lots of information on the nxthera website and there are many videos on youtube and similar. Take a look and you'll find quite a bit of info. If you are looking into this treatment, be sure to find a doc who has done at least a couple hundred of them and who will not try to talk you into doing it under "local" anesthesia.

Best,

Fred

Thanks Fred,

I will research further as I get closer to a procedure. Curious if all those injections are done during one procedure or if they are all separate procedures?

Patrick

one procedure

Hi Patrick,

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Sorry about the delay in replying but I have been busy skiing. It is good to be able to make yellow snow again!

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With Rezum, a series of "steam injections" kill prostate tissue and then over time (about 3 months), the body removes the dead tissue resulting in a reducing the size of the prostate and clearing the obstruction.

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After the injections, there may be some episodes of prostate swelling which further blocks the urethra. I had 2 of these over 3 months. Also there will be episodes of peeing out dead prostate tissue.

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The advantage of Rezum is that the steam injections just puncture the urethra and then destroy tissue within the prostate. In TURP, GLEP and HoLEP, a section of the urethra is removed as the prostate is hollowed out. Over time, new urethra cells will line the hollow.

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This is one of the reasons for RE. Think of the hollowed out section of the urethra as the reservoir at the end of a condom, but now the reservoir is at the start point and not the end point.

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I am still self-cathing 2 times a day just to get PVR values for my Excel spreadsheet and graph to track my bladder recovery as I do not own a bladder ultrasound scanner. My PVR's are in the mid-90's ml. Self-cathing before going to sleep at night makes for better sleep.

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Steve

Steve,

Thanks for sharing your experience with Rezum. I will most probably be sticking with CIC at least until my uro suggests a next step. Good luck to you!

Patrick