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

Self-cathing is an adjustment, but small compared to some situations and conditions. Cathing into a measuring cup (or plastic bottle pre-marked with gradations, my preference), will let you know just how much urine is NOT being peed out.  It IS important, as retaining large amounts can lead to UTIs and other complications.  Because of a "lazy bladder" (I just made that up--- it's too stretched from the history of retention, to return to its unstretched size.), I will likely always have to cath some, even though I can do it normally, if there's enough liquid in there to prompt the physical signals.  

But yes, learning to cath gives you (collectively) control over the situation, which is WAY better than the alternative!  

Most of us would probably say 'it depends' and what it depends upon is can he pee on his own ?  If he can, or even if he can most of the day, but not at night, then do without the Tamsulosin.  Rely on the self-cath for output when he feels he needs to.  He may find after the worst effects of total retention wear off, he will be pretty good without anything at all.

Tamsulosin (Flomax) is an alpha-blocker that relaxes the muscles in the prostate and bladder neck, making it easier to urinate.

Tamsulosin may cause dizziness or fainting, especially when you first start taking it or when you start taking it again. Be careful if you drive or do anything that requires you to be alert. Avoid standing for long periods of time or becoming overheated during exercise and in hot weather. Avoid getting up too fast from a sitting or lying position, or you may feel dizzy.

Tamsulosin can affect your pupils during cataract surgery. Tell your eye surgeon ahead of time that you are using this medication.

Generally, I think it takes some time to start to work, and can be quite hard to tell if it does anything anyway. Sometimes you can only be sure it helps when you stop !

 

5mg (one a day Cialis) helps the flow and has better side effect than Tamsulosin. Tamsulosin can also cause reduced sperm output and retro. 

I once asked the nurse at my GP practice what was the most complained about drug, She said, Tamsulosin and that is by wifes!

 

In terms of emptying the bladder and protecting the kidneys, self cathing does what Tamslosin was designed to do but does it much better in that self cathing completely empties the bladder any time you want. As far as "retraining" the bladder, I would go for an agressive self cathing program as discussed in the self cathing threads. Also, self cathing can be "passive" or "active". In other words, you can just put the catheter in and let it drain or you can help the process by pushing the urine out with the detrussor muscles. I believe the latter is a better idea in that it will help excercise them. 

To your specific question, as another poster said, "it depends". While not really necessary there may be scenarios where your husband wants to decrease his cathing intervals by increasing his natural urination. More lifestyle choice I think,then what is good or not good for the bladder. But of course there are the side effects to contend with as well. 

Personally I rehabilitated my bladder over the course of a couple of years to the point where I could almost stop. So then I introduced Daily Cialis to see if it could get me to the pont where I could stop self cathing completely. It almost did, but not quite, so I stopped taking it seeing no real benefit. 

Got to experient with these things, we're all different. But right now, with your husband new to self cathing, best to just concentrate on the basics. Have him measure his urine output with a 500ml plastic cooking cup noting how much comes out naturally and how much comes out through the catheter. 

If more than 400ml comes out through the catheter at any one time then he has to increase the number of times he catherizes each day. 

Later on, you might want to get more agressive and try and keep the total bladder volume under 400m which would be the sum of his natural void and the catherized void. 

Jim

Just to expand on pushing with the detrussor muscles while self cathing. Maybe not a great idea right in the beginning while his body is adjusting. If he does it naturally fine, but don't force it. But later, when the body has adjusted to self cathing, it's a good idea to do this from time to time, especially if he isn't doing much in terms of natural voids. As his natural voids increase, then again less important.

Jim

Its a side effect vs. benefit secnario. Does it do enough so that he doesn't have to cath? There are other alpha blockers too - Alfusozin is generally side effect free and often works just as well - he might want to switch to that.

I'm going to disagree with some of the self cathing advocates - its certianly a WAY better option than a foley, or many of the more invasive, potentially problematic procedures (like TURP) and can free yo to live a reasonably normal life, but its far from ideal. Its up to your husband, but if there's a way to pee normally and not have to rely on a cath - even a handy, well concealed one, it would be plan "A" for me.

There is a reason for his retention and he should see a urologist to have the necessary tests to determine what it is. There are (lots of threads on them here) new, non-invasive outpatient procedures available that weren't even a few years ago like PAE, Urolift and Rezum. The liklihood is that your husband can have something done with pretty quick recovery/minimal side effects that will solve the problem and free him from any catheter if that's important to him.

Oldbuzzard said: I'm going to disagree with some of the self cathing advocates - its certianly a WAY better option than a foley, or many of the more invasive, potentially problematic procedures (like TURP) and can free yo to live a reasonably normal life, but its far from ideal.

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As a self cathing (CIC) "advocate" it's unclear what the "disagreement" is. I don't think anyone has said it's "ideal". What we have said is that it's a viable option either short or long term. 

Short term, CIC allows you to extend the "watch n' wait" period letting you consider current options in an unhurried manner, as opposed to being rushed into a decision because you're afraid of locking up or doing damage to your kidneys. 

Longer term, CIC lets you wait for better options. The latter is what I have been doing for the past couple of years and during that time my bladder has been rehabilitated to the point where most of the time I void naturally and only need CIC on occasion. 

Frankly, at this point CIC has become so fast, painless and easy that I would be hard pressed to try any of the current procedures or operations in that all of them carry some risk. 

Jim

If he's peeing normally (he should cath once after emptying just to be safe) and hasn't had problems previously, he's probably fine - at least for the foreseeable future. He should probably keep a couple of those speedicaths in his car and also in his travel bag when away from home for safe keeping and peace of mind, but may not ever need them. Based on what you describe, he doesn't need any meds and this is pretty close to the ideal outcome.

6 is kind of high for a PSA, but as has been pointed out, could well have been inflated due to his temporary condition. Another PSA test isn't a bad idea just to make sure that 6 isn't real - but its highly doubtful he has cancer and on the remote chance he does, what they call watchful waiting is often the best approach, as only 5% ever grow enough to be an issue and there are ways of isolating which ones are most aggressive.

Most likely this is just a lousy couple of weeks that won't repeat - I hope that's the case. 

It all sounds very good and must have been a one off. Stop worrying and get on with the other event in your life.

No reason that he should have any cancer cells it is really not that common. The media and cancer charities run so many scare stories that peoples first though now turns to the Big C.

The tissue removed at my last procedure when I was 78 did not show any and as I have said my PSA is now 0.74. 

If he doesn't want to self cath to check his PVR (post void residual) why don't you just go back to the doctor and have them do a bladder scan right after he urinates. Most urologists now have bladderscans right in the offfice. 

Jim

That's a good idea.  I favor the self-cath approach, though, and a recent health visit serves as an example:  I had a scan done, and the tech said there was 90cc in my bladder.  She then double-checked, with another scan, and said it was only 60cc.  I then self-cathed, to give them a pee sample, and drained 150cc into the cup.  Just sayin'...  :-)

I've also suspected my urologist's bladder scanner underestimated my PVR by a little as well. Although, must say, the one time I challeged him and self cathed right after, they were almost the same.

The other thing is that it's very hard to compare one against the other because the kidneys can dump significant amounts of urine in a very short time. So, that could account for the difference sometimes. For example, one ultrasound showed a larger bladder volume POST void than PRE void. So how is that possible? Probably because they had me drink a gallon of water prior to the test! In the real world, probably not so dramatic a kidney dump.

Then there are the "studies". One study suggests that even self cathing doesn't always empty the bladder to zero where they compared to ultrasound. That would favor ultrasound as more accurate. But then another study says bladder scanners underestimate which supports cartoonman's experience.

A little off topic, but one thing I have found is that by changing my pelvic position a little in a half squat,  I can sometimes drain 10-50cc more out of the bladder. But then again, I have a bladder diverticulum which confuses the issue because tilting the pelvis simply might be emptying the diverticulum into the bladder which then comes out of the catheter. 

Maybe someone without a diverticulum could try changing pelvic positions and/or a half squat when the catheter stops flowing and see if anything more comes out. 

Jim

I'll try that out---as soon as I learn to say, "Diverticulum!"  :-D    I guess if it's a new word for me, I don't have that issue!

In the UK GP's have little in the way of equipment and he has yet to see a urologist.

Thanks Derek. Not that familiar with health care on the other side of the pond. How hard it is to get to see a urologist? Here in the states, if you're on Medicare, you don't even need a referral from your GP. You can call up a urologist directly. If you don't like that urologist, the next day you can make an appointment with another one. And then another one.  I guess we are spoiled.

Jim

We get 10 minute appointments with our GPs who nowadays practically appologise if they touch you. I can get an ECG or a 24 hour BP monitor at the surgery done by the nurse but not much else. My GP has done a DRE for me. When my wife went after passing blood from her back passage he was reluctant to do an examination. Mostly they will refer you to a consultant.  

The NHS is supposed to have an 18 week limit for the initial consultant appointment and treatment. It rarely happens. Some parts (very few) of the country have 'choose and book' where you can pick your hospital and consultant after finding the best option. 

Last year I waited 26 weeks to see a neurologist when the hospital website said that it should be 12. I was then referred to a neurosurgeon. The waiting time was said to be 34 weeks so I arranged to see one privately. I stayed on the NHS list as well and when I last asked it had gone out to 39 weeks.

 

 

That must be very frustrating. If today I wanted to see a new urologist, I would simply call their office directly and probably have to wait no more than a week, possibly less. My GP is great but I no longer need him for referrals, just general stuff and that's mostly via emai which he responds to the same day. Not to say that we always get the time we need when we see the doc, but if the first doc rushes us through or is otherwise unsatisfactory, there is always another. There are some docs, and some very excelent ones, that do not take Medicare so those are out unless you pay out of pocket. But still a lot of good ones that do take Medicare, and most of the docs at the the large teaching hospitals accept it. 

Jim

We need to be referred by our GP even to see one privately.

You normally just see the same consultant but at a different location.  

It may be like that here in the not too distant future, but hopefully distant enough that it won't affect me too much. 

Jim

In emergency the NHS is very good but less urgent things they just don't have the capacity to cope with.

I don't know about your ER but here you can wait up to five hours to see a doctor or nurse practitioner and sometimes about two hours to see a triage nurse to be asessed.

Part of the problem is that people cannot get appointments with a GP so go to A&E (ER) GP's in the main work 9 to 5 and no weekends.

The GP's at the practice I go were working a three day week but all seem now to work four days due to lack of doctors. One who has had a few pregnancies works very little and a husband and wife team do Job Share.