Bladder Urinary Retention Causes and Cures

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Bladder Urinary Retention, aka. Postoperative Urinary Retention and POUR, is very common and can be precipitated by the anesthesia and opiates administered just before recent operations including lung, prostate, and other operations, especially. if the patient is 60 years old or older..There are other medical profile indicators, ie. high blood pressure, that could also cause the patient to be a high risk for POUR...The Cures include Self Catherization, Behavior Modifications & Techniques, Medications, Neuromodulation, etc......to learn more GO TO anesthesiology wwbsite of the Journal of the Society of Aesthesoologists......A lot of surgeions are unaware or have forgotten that POUR is a high risk for specific and primarily older surgery patients.....FYI - I have POUR that was precipitated by the items mentioned above during a lung cancer operation in June, 2016...Neither the lung surgeon nor 2 urologists since know how to treat the POUR...As a result, I've been on a Direct Straight Catheter since the operation, because my bladder muscle will not function and, as a result, I can't VOID, Pee, as I should......This information may help you if you are experiencing Urinary Retention too...I hope this hel;ps!...

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    Hi Randy,

    Sorry to hear what happened. Don't know your history, but my guess is that you probably had other underlying issues such as bph prior to the surgery and that the anesthesia pushed you over the edge into rentention. Could be wrong on this. 

    But in any event, three months is a long time to be on an indwelling catheter (Foley) because you can't void on your own. At this point I would ask to be put on a program of self-catherization (CIC). It's a simple and easy way to empty your bladder completely without having to have a tube in your urethra and wearing a bag. I personally have been self cathing for around 3 years now and can attest to its effectiveness.

    Self cathing also allows you to use your bladder (detrussor) muscles so I would think if you have any chance of regaining your previous bladder function, self cathing would offer you a better chance than just using an indwelling Foley where the muscles aren't exercised at all. I would also consider getting another opinion from a voiding expert as your current doctors don't seem to have any answers. But first get off that Foley, learn CIC,  and start to live more of a normal life. 

    Jim

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    • Posted

      My urologist advises against self cathing due to the nature of my medium lobe. He states I have to negotiate a curve and current catheters can't do that. Thus, he says I would injure myself by trying to self-cath.....He, a prior Uro, and my lung surgeon Do Not and Did Not offer a treatment for POUR and seemed not even to be trained for it or aware of it...Question - I've had a REZUM which should releave the pressure on the urethra so it can function normally....Thus, it seems my VOIDING PROBLEM is caused by the Bladder Muscle not functioning as it should when we try TRIAL VOIDS. ...There are medications and neuromodulation that are suppose to stimulate the bladder muscle so it will perform...I'm trying to contact a POUR Specialist now....

       

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    • Posted

      The only way to tell if you're median lobe is the problem is with a scope - he's just guessing.and you're far enough past the procedure that it should be down in size at least somewhat. And remember, everyone who self caths due to an enlarged prostate has something that the cath needs to navigate around, otherwise they'd be peeing the normal way.

      Curved tips (Coude) were desgined for that problem and the only way you'll know if you can do it is to try - I'd be shocked if you couldn't this far after the procedure. When I had Rezume, there was one spot that almost always cuased a problem, but I cound that a certain angle with the curved tip did the trick. And remember, if that lobe precluded you from self cathing, how is it they're getting that Foley (typically much larger thant the 14s most people use to self cath) up there every time? Those pre-lubed speedicath 14 slide up there very nicely - much more easily thatn anything they use in hospitals or doctor's offices.

      Bottom line - you can already pee some (as eveidenced by your problem on the way to the docs office) and you won't get better until you excercise your bladder. Find someone who will show you how to Self cath and write you a script for caths and this nightmare will probably be over in a matter of weeks - and in the meantime you can live normally. If you wait, you'll be on that Foley indefinitely, because a domrant bladder won't return to normal function without being used and excercised.

      Time for a new doc IMO.

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    • Posted

      Hi Randy,

      We're not doctors here, but I will tell you this from my personal experience that the majority of urologists know very little, and have very little experience with self cathing. And your doctor is not even currently a urologist -- a "former" urologist you say, now a lung doctor!

      His take that "(you) would injure yourself" with self cathing due to the nature of your median lobe, doesn't sound right to me at all. Could it be As mentioned by "oldbuzzard", there is a catheter designed to go around difficult and enlarged prostates. It's called the "coude" catheter. My recommendation would be to start with the Speedicath Coude Tip size (FR) 14 by Coloplast. If for some reason that doesn't go around the prostate you could try another size. 

      You owe it to yourself to at the very least get a second opinon on this ASAP from a urologist who is familiar with self cathing. You might want to look for someone in a teaching hospital who treats SCI (spinal chord injury) patients. Self cathing is their go-to method of emptying the bladder.  

      Jim

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    • Posted

      Can you provide the information to order Coude Caths? ...Or do I just Google Coloplast?......Doesn't someone, ie. as nurse, have to teach you how to Self Cath?...FYI - I've just set-up an appointment with another Urologist to discuss (#3) Self Cathing and other POUR treatments.....You misunderstood the doctors I've seen...#1 Lung Cancer Surgery June, 15 which caused the POUR, #2 URO DOC #1 who ignored the POUR Complaint ran tests and wanted to do a TURP Only. I Decined the TURP, #3 URO Doc ran tests performed REZUM on Agust 15th...No Improvement for Retention, I can't VOID.....The REZUM should have removed enough tissue to correct the BPH, but it did nothing to help the Bladder Muscle...If the Bladder Muscle doesn't push the urine through the urethra, then, I still won't be able to VOID, even if, I Self Cath...Isn't that true?...I could SELF VOID without any problems before the Lung Operation, but have not been able to since...I may have had a BPH problem that needed the REZUM procedure, but it seems like both URO DOC's have ignored my initial complaints to cure the POUR so I can VOID normally....

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    • Posted

      Self cathing will work regardless of the state of your bladder. People paralized above the waist are able to do it just fine. IF you had no issues prior to surgery, then the Rezum may have been unnecessary, but given your situation, a prostate that wasn't a problem before might be now, given the state of your bladder. And you'll need a prescription in order to order a catheter.

      Bottom line is you need to excercise your bladder and get it moving again. The kind of problem you had post surgery shouldn't last more than a couple of weeks - hopefully your new doc will understand the situation and treat it. If you can pee some, chances are with excercise (try to pee every time - then use the cath to empty) you'll be functional before too long.

       

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    • Posted

      Hi Randy,

      The catheter many here recommend is Speedicath Coude 14F. Product number: 28494. HCPCS Code: A4352.

      Ideally, your doctor or nurse will show you how to do it. Unfortunately, many do not have the experience. Fortunately, many videos YouTube, some from Coloplast. The main thing to keep in mind is to be very gentle and never force anything. You also want to make sure to orient the coude tip properly per the videos or your instruction. 

      Self cathing will not necessarily solve your problem, just like your Foley won't necessarily solve your problem. But what it will do is free you of tubes in your urethra and a bag on your leg so that you can live a better life until your problem gets solved. 

      Let us know if you end up with catheters and a number of us can help you with further questions that may arise. 

      Jim

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    • Posted

      I greatly appreciate you and Jim James helpful suggestions. My current URO doc is anti-Self Cathing and that may be a solution so I guess I need to change URO Docs for the 3rd time...Self Cathing is "one" of the "helpful treatments" for POUR, Postoperative Urinary Retention, mentioned in clinical trials... The Two of you plus most all the men on this forum endorse and recommend the Self Cathing so, if I can find a URO Doc who'll prescribe the catheters and teach me how to use them, I'll try it...I Don't Have Much To Lose!....Thanks, Guys!... 

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    • Posted

      If possible, start looking at a teaching hospital. A call ahead to the doctor's nurse prior to the appointment can also be helpful. Ask the nurse if the doctor has self cathing patients and if he supports and writes rx's for self cathing when needed. If the answer is "no" or non-committal, call another doctor. You could also try finding a urologist who caters to the SCI (spinal chord injury) community. In the SCI community, cathing is the go-to method of bladder emptying, so any urology practice serving that community should have experience in self cathing. 

      In most cases self cathing is far superior to an indwelling catheter. But if for some reason it doesn't work out for you, then Plan "B" would be a Suprapubic catheter with possibly a flip-flo valve. Again, this is oftenbeyond the "pay grade" of your garden variety urologist so seek out a large teaching hospital.

      Jim

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    • Posted

      Hi Randy,

      None of us are doctors here. Keeping that in mind, my understanding is that the treatment and outcome of Post Operarative Urinary Retention depends a lot on the prior condition of your urinary tract such as whether you have an obstruction, etc. As I mentioned in the previous post, you really need to see a urologist, preferably at a larger teaching hospital who can help you.

      Meanwhile, you of course have to empty your bladder and that is why you have an indwelling catheter at the moment. Better alternatives to a prolonged indwelling catheter would be self catherization or a suprapubic catheter. But at this point it seems that your first priority is getting to another doctor who can help you manage all this. 

      Jim

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    • Posted

      I set-up an appointment with a URO Doc that suppose to be experienced in treating POUR for Monday....Also, I've contacted Emory Univ Medical Center Hospital too, a teaching hospital, as you suggested..........Why are you still Self Cathing?........

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    • Posted

      Randy, sounds like progress. Just make sure when you see the doctor's that you not only listen to them, but also make sure you voice your concerns about the indwelling Foley catheter. Tell them that until you are able to urinate on you own that you would much rather prefer to self cath than be burdened with a Foley catheter and bag. The second choice would be a suprabupic with flip-flow valve but I would start by asking for an rx for the Coloplast Speedicath coude FR14. Unfortunately, sometimes docs don't consider our quality of life when they prescribe a treatment plan so that's why we have to step up and make our voice known.

      I started self cathing because I had severe chronic retention and was very close to acute urinary retention, ie being unable to urinate at all. To make a long story short -- the longer story is in one of the self cath threads -- I decided against the operation and went on a self cath program instead. I am still self cathing today because it has worked out so well that at this point I do not see any benefit of having an operation.

      Jim

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    • Posted

      I am 72 years old, a retired banker,  but work part-time as a public school teacher , as well as, teach real estate finance.....It's embarrashing having to deal with the direct foley catheter and leg bag.....plus it causes a lot more problems....

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    • Posted

      You can live completely normally and do your job with no issues self cathing. They make a portable speedicath that is pre-lubed. You can discreetly slip into a stall and no one has to know. It will take about an extra 20 seconds (more than the natural way) once you get the hang of it. The good news, is that you'll probably be able to manage without the cath within weeks.

      Good luck, let us know how it goes.

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