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

A PSA of 6.1 is normal. But I hope he explained that this is not an absolute diagnostic indicator. It is possible to have a low PSA and still have prostate cancer, or have a high PSA and be clear. Did he carry out a digital rectal examination as well?

I'd wait and see what happens after the catheter is removed. If your husband can pee OK, then wait for the NHS appointment. If he can't pee then it's worth going private. That's what I did. BUPA on demand could get you an appointment next week, if not sooner - cost £250. Make sure you take your GP's referal letter with you. 

 

Thankyou Patrick....yes, he did a rectal exam last week and said that the prostate is enlarged but smooth and did not feel ' worrying' 

Just as Patrick says, there is no clear reason for concern at all, and when I read what your hubby did to precipitate this alarm, one can only laugh !

Get the catheter out, learn to self-cath as a purely self-defensive option, moderate the intake of this and that, and the chances are excellent that you can wait months for an appointment with a urologist, who will do no more than another PSA test, digital exam, and probably flow-rate test (pee into an electronic urinal), and put him on 'watchfuil waiting'.

Very happy for you so far.

It doesn't seem that his PSA is all that relevant. And unless the number is really big, changes by % in PSA scores over periods of time are more indicative and predictive than one isolated number. Again, cancer grows progressively - you don't typically wake up one morning unable to pee and find out you have cancer. This is most likely a BPH issue. 

I'd start by getting a self cath lesson and prescription for caths so you can get those spedicaths that everyone likes. He may not need one, depending on what happens when they remove the cath. I had a trip to the ER once when i was totally blockec up, and didn't need to cath again til I had surgery (anasthesia and opiates can lock you up) a year later and not again for another 3 after that.

Given the wait times just to see a urologist, you might want to go private if you can afford it. It could be awhile before you can get any procedure (not familiar with how ti works in the UK). Also, I'd recommend that make sure you see someone who can do Rezum/Urolift or one of the less invasive procedures that don't bring RE as a side effect. He can always do something more extreme if you he doesn't get acceptable results, but at your husband's age with young kids, there is no reason to risk some of the complications the surgical options bring into play unless its a last resort. 

I respectively disagree. When I locked up 4 years ago the lesat invasive option was the gree laser and I opted to wait. But its been a real pain in the butt and annoying as can be. If I could turn back the clock and solved my problem 4 years ago with few complications and no RE I would do it in a heartbeat. Too much coffee=problems. Too much alcohol=problems. Decongestants=problems. Opiates=problems. Waiting too long to go=problems. Now that there are several ways to deal with this without long recoveries or sexual side effects, if I'd say get it fixed sooner than later. This problem won't go away and I know some are fine with it, but indefinite self cathing isn't ideal either.

There are many who would disagree with me and I urge you to consider what they say and apply both approaches to your own situation. Only you know what you can afford, how much inconvenience you find acceptable and ultimately what your best option will be.

When did he do a DRE to estimate his prostate size? I can’t see that looking back on earlier posts. Even a GP should be able to tell not only the size but the condition of the gland. As has been said his PSA will be up from the catheter being in.

An initial NHS appointment will lead to another wait for a flow test and a check for retention although some hospitals now do that first and a urology nurse practitioner does the DRE. 

 I doubt if even the second appointment will include a TRUS (transrectal ultrasonography) or a cystoscopy and it will all drag on before your battle to get the treatment you want starts if it turns out to be required.

I imagine even privately not much would be done at the initial appointment as the Uro would not set anything up until he made his initial diagnosis. A TRUS and a cystoscopy if deemed necessary costs around £1500 at a Spire hospital, a rip off for procedures that only takes a few minutes. 

Personally I would wait until you see how he gets on with self cathing. If it is BPH it ain’t urgent but if you take the medication route it leads to side effects and the future fertility problem.

Alcohol and antihistamines are a deadly duo:-)

 

Because (unless he's permanently locked up) this is an elective procedure, a flow test is probably unnecessary. He knows if he can pee accpetably or not. You can check for rentiion yourself - pee as much as you can, then cath and see how much remains. I would find long term slef cathing to be a real pain - your husband may not. many disagree with me, but the idea that I could go to the bathroom without a second thought is heavenly. BPH has run my life for way too long. Still hoping that the REzum I had done will solve the problem.

Good idea checking your retention by cathing. Not having cathed that did nor occur to me.

As I have stated here and elsewhere, PSA is meaningless. My own was 2.4 to 3.5 over a decade, yet a 3T MRI w and wo contrast showed a suspicious left lobe area causing the usual urination issues. The subsequent targeted Biopsy gave a Gleason (4+4) 8, which after removal by Robot-assisted surgery was a Gleason 9.

Luckily, the PCa was confined to the prostate, and the nerve bundle on one side was left intact. I am not on any post-op treatments or medications, and back to physical activity and a few red wines when it suits.

In summary, pay the price of a 3T MRI, and stop all the guesswork about why your husband cannot urinate.

I am very sorry for what you have gone through but your post has me sat here in tears at 1.30 a.m!! 

We we really do not have the money for an MRI and I am now terrified!!

It's unlikely that it's cancer and if it is, unlikely to ever cause a problem. Only 5 % ever do

Thankyou! 

I was going to talk to hubby about trying to find the money for an MRI privately but......

I have heard that too much testing find things that are then treated that may well be better left alone as they like you say never cause a problem? How do you gents with BPH make the decision not to get throughly tested for PC? 

Mainly what the urologist thought of how the prostate felt and then the PSA readings that are now not trusted. I don't think when I had my first PSA test and biopsy in 1995 that they did MRI scans on the prostate. I had another biopsy  around 1998 and then forgot about it on the basis that my large prostate caused the high PSA. When I was at the hospital to have it done another urologist asked why I was there. His answer was PSA terrorism!

Personally I think that you are over reacting and that his sudden retention was caused by his night out. If your GP suspected PC he would have fast tracked your husband to a urology appointment. In circumstances like that he can have you seen in two weeks.      

Testing?? I had a scan on my gall bladder that was OK but it found a 3.1 cm Aortic Aneurysm, many harmless cysts on my liver and four on my right kidney that are growing but I'm told are harmless.

Now I have scans every year on the aneurysm that in 14 years has only grown to 3.7 cm but makes travel insurance a problem as they don’t understand that in this case size matters.

In all honesty, I can see your argument about being sure there is no cancer, but the reality is even biopsys are rarely conclusive, but quite commonly lead to severe infection, ie. Prostatisis.

Now his wife has reported her husbands slowing of flow over a period of time, AND a very stong reason for sudden retention. The gentleman took an antihistamin for a known allergy to red meat, then immediately went out and ate some, along with five pints of alcohol.

Everyone on here knows the typical result of antihistamine and alcohol will be acute retention if there is even minor flow restriction.

So on balance everything is explained with no reason to expect any worse problems than most men have to put up with ageing and raising anxiety is unfounded.

Your reply has calmed me right down Thankyou. Please forgive my hysteria last night..... Hormonal/ pregnant woman worrying at 2a.m never going to think rationally  

Derek76..... Thankyou also ..... Your reply has given me a good slap back to common sense. I appreciate you all holding my hand through this and will try to stay calm! 

Ali

Everything looks better by the light of day.

Which part of the country do you live in as some are very backward in their urology thinking.

Where we are the local hospital only offered me TUMP ot TURP and were anti Laser. I insisted they refer me to an other area where one of the countries top two urologists consulted. At that time he felt that my prostate symptoms were not too bad. 

Some time later I got a locum urologist at the local hospital and he expressed amazement at their attitude and told me that Mr X  had been doing laser surgery at the hospital for years and referred me to him.

 

Derek76..... We are in the Southwest.... Very close to Plymouth. Only a Turp been mentioned by GP and when I asked about alternatives such as Uroloft,PAE he shook his head and said he knew nothing about them. We are now on a waiting list to see a Urologist but now knowing which one I don't know if they are open to doing other procedures. 

The GP did gulp a bit when I told him that weren't happy thinking of a Turp as we may not have finished our family( all the other reasons as well but thought that would hit home the hardest) ...... I am not sure if that would qualify my husband for a Urolift or PAE on he NHS or not? 

HE may not need anything. I missed the past that described what led to the retention. He's probably fine when the cath comes out. Get some speedicaths for safe keeping and try Alfusozin if his flow is slow (much less likely to cause RE). He almost surely can manage things easily til he can see a Urologist - even through NHS.

If he's fine and has a reasonbly normal flow now, I'm not sure I'd even recommend PAE or one of the other less invasive procedures. Someone has problems even with a 2% chance. I set a length of time on cath record for Rezum patients and I'm otherwise perfectly healthy. Don't as for trouble where none exists.

Good luck - if things aren't good when the cath comes out, or if they regress soon, then I'd see a urologist, pay if you can/.have to and look into PAE/Uorolift/Rezum.

Interesting that the UK leading centre (virtually the only centre at the moment) for PAE by interventional radiologists is at Southampton (university and Spire hospitals I think). When or if hubby ever needs some prostate shrinkage, PAE is often touted as the best current option. I am waiting for this procedure to appear in the Midlands myself.

I was just about to post alil links to the Southampton urologists and radiograhers that I can't post here. I still will. Southampton is at the forefront in many procedures.

When I inquired about heart valve surgery they even said that they would match any other prices elsewhere and do it the next week. In the end I waited for the NHS.

Hi AliL,

I think PAE is the most promising; however, so that you go in with eyes wide open I wanted to let you know that there is a possibility of embolization of the seminal vesicle - so my doc, just before the procedure, asked me if i still wanted to have children!

My apologies for upsetting you. I wrote a much longer reply, but in the interests of it calming you, have settled for those shorter reply.

A PSA of 6.1 may or may not be normal. For his age it is not likely normal. However, it might be normal for the size of his prostate. I would encourage an MRI but there is a less expensive test called a PCA3 test. This is a urine test and is not influenced by the size of the prostate. If this test comes back with an indication of cancer then I would recommend moving forward with an MRI (make sure it's a 3T MRI). If the PCA3 test comes back negative, then I would move forward with urolift or PAE procedures. The PSA TEST can be influenced by ejaculation and even from the DRE if done right before blood is drawn. The best use of the PSA is to use over a longer period to monitor if it increases over time. Otherwise the PSA score by itself (unless the score is very high) is not a good indicator of cancer. I'm not a doctor, this is just based on what I have read and personal experience.

Thank you so much for your reassuring reply

Thankyou! Yes it seems he kind of dug this hole himself when we look back. Praying things return to normal once the cath come out and your reply is very encouraging.

Please don't worry. I overreacted...... Middle of the night!! But we will be keeping hold of your advice re the MRI if things look worrying in the future. Thankyou.

Thankyou for sharing your experience with me. Our GP did agree with you that's it's high but put it down to the acute urinary retention ( which was very severe thanks to a disgraceful attitude in A and E who left him for hours) ,the catheter and his enlarged prostate. We will retest but maybe if the PSa is not reliable if he is self cathing perhaps we should ask for the PCa3? Do they agree quite readily to this test?

The PCA3 test is not available through the NHS at the moment. It is being assessed by the National Institute for Health and Care Excellence (NICE). It is available in a few private hospitals and clinics. The cost is between £300 and £400. You could talk to your doctor about whether it is an option for you.

How you have the PCA3 test 

The test is in two parts. You have a rectal examination and then a urine test. 

You need to have a rectal examination because this massages the prostate gland and helps the PCA3 to go into the urine. You have to give the urine sample straight after the rectal examination. You normally get the results within a few days. 

Thankyou Derek,this is very helpful. No, we have only had the PSa. 

I've also sent to a message thanking you for all the very helpful links you have sent me..... But thanks again!

Ali