How fast does it damage happen in the bladder from BPH or retention problems?

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I have been taking alfuzosin 10 mg for the last year. However its effectiveness has declined so I doubled up alfuzosin twice a day. The pharmacist said that's not recommended. But it seems to working better though not great. I don't want to take any other medications because all of the others seem to have terrible side effects. Lastly, I noticed recently slight pain in my bladder region. I'm not sure if it's all the stress the bladder has been in cheering for the last year and a half with retention problems. I'm trying to get a new urologist. Because the one I have only does old-fashioned Turp and doesn't seem very concerned. He doesn't see the point I'm getting an ultrasound. He just keeps saying got to do the Turp.

How fast does it damage happen in the bladder from BPH or retention problems?

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  • Posted

    Yes, definitely get a second and third opinion before you TURP. I did urolift a year and it worked well for me.

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  • Posted

    Its a good question and I would imagine the answer has to do with how long one has had the retention and many other factors..genetics.

    I'm doing cic and have been for 2 1/2 years now. Still having to do about 4 a day, but medicare coupled with my medigap plan pays for the catheters. UTIs haven't been a problem for me fortunately. I had prostatitis which drew my attention to my retention problem. For me, BPH has been marked by an almost complete inability to feel when I have to pee. Evidently the nerves in my bladder got stretched to where they didn't alert my brain anymore, at least not until I was retaining way over 400 ml. I've never taken any prescription meds until recently when I've tried the 5mg. Cialis tx. So far, the help for my BPH doesn't seem much better than some of the OTC aides. Kinda like the other side effect though (:

    I have noticed from time to time a slight pain in my side or different places where my bladder should be. It passes after a while. I think its possible that it IS a good thing, a sign that there is feeling coming back into the nerves as I keep my PVR low with cathing. I know that some of the feeling has come back. That is the most noteable thing so far in recovery is that I don't have to go exclusively by the clock like I was in the beginning. I almost exclusively just use my urges now to tell me when its time. Also pressing on my bladder just above the groin the try and gauge my retention.

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    • Posted

      Keith,

      I feel your pain. Like you, my bladder muscles were damaged by a "massively distended bladder" that was discovered with a CT scan in the ER after a spill off my bike. Over 5 liters were drained and I went home with a Foley and referred to a urologist. Before my bladder was drained, I was urinating regularly, but after it was drained was not able to urinate at all, and after failing a urodynamics test, was offered the option to self-cath, so now I am self-carhing 6 times a day in hopes of rehabbing my bladder enough to regain bladder function so I can void naturally again.

      Like you, I obviously had nerve damage as I was not alerted to void my distended bladder even though I was urinating regularly but was not aware of my urinary retention until my ER visit after the bike fall. My uro advises that the retention is caused by BPH, but does not yet recommend a procedure until I regain bladder function. "No use in expanding the pipe until the pump is working".

      So I'm not in a hurry to rush into a surgical procedure that my uro says has only a 20-30% chance of success and live with the undesirable side effects. Some have been able to rehab their bladder with CIC enough to stop self-cathing, so that is now my goal while I research alternative BPH treatment options.

      FWIW, I also feel sensations in my bladder from time to time and am keeping my fingers crossed this is a good sign of bladder healing and rehab. Curious if you are able to void without a catheter after 2 1/2 years of CIC. I sometime get urges, but so far no go. I hope this changes sooner than later!

      Good luck,

      Patrick

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    • Posted

      Curious if you are able to void without a catheter after 2 1/2 years of CIC.<<

      The short answer is no. I notice that if I drink the amount of water that my GP recommends I get more urges and probably would be able to urinate more. I drink a lot of strong black coffee which may be irritating my bladder slightly which may cause my urges sometimes. I still can have a strong urge and go into the bathroom and after about 30 seconds with no urine production, the urge goes away for about 20 min. Then usually it returns and often there is maybe only 200 ml comes out with the catheter; sometimes more. But I can't remember lately as much as 400 ml coming out which is the threshold that Jim James used to say was a safe threshold. Staying under 400 should prevent further bladder damage according to him. I'm going to see my urologist tomorrow to check my PSA level which has been elevated; about a 7 I think the last time.

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    • Posted

      Keith,

      "I drink a lot of strong black coffee..." Look up overactive bladder foods to avoid - the coffee may be irritating your bladder. It's likely you are addicted to the caffeine but if you could get off the coffee it might help your symptoms. My bladder is overactive and I avoid caffeine.

      Tom

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    • Posted

      *********> * But I can't remember lately as much as 400 ml coming out which is the threshold that Jim James used to say was a safe threshold. Staying under 400 should prevent further bladder damage according to him

      After reviewing my output log on my last visit, my uro increased my prescription from 4/day to 6/day as many of my PVRs were well above 400ml , especially my noon void after drinking my daily two cups of coffee. Although my PVR s have come down, I still get some over 400ml. But when I reduce fluid intake to keep my PVRs down, my urine becomes darker in color which is a sign to increase fluid intake. I can tell what volume a void will be as soon as I start voiding...if it is darker in color I know it will be a relatively small void and if it is lighter in color the void will be a larger volume. As such, I try to strike a healthy balance.

      Since I have afib, it is important to stay well-hydrated to avoid triggering afib episodes, and I ride my bike 25-30 miles every day in the Florida heat, so I take two 24 oz water bottles with me on rides which tend to increase my output and PVRs. However, since I had over 5 liters drained during my ER visit 3 months ago which started this urological adventure, I don't think I can do any further damage than what has already been done and am hoping my CIC regimen will facilitate rehab and repair of my bladder.

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    • Posted

      Coffee is habit-forming but I like to save the word addiction for more severe cases, such as morphine or alcohol to an alcoholic. I probably drink too much. I guess if I had to have the caffeine I could get one of those little bottles of energy drink.

      The diruetic effect of caffeine definitely works on me and I'm sure I'm peeing out more fluid than I'm taking in if I only drink coffee and no water along with it.

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    • Posted

      <<Since I have afib, it is important to stay well-hydrated to avoid triggering afib episodes, and I ride my bike 25-30 miles every day in the Florida heat, so I take two 24 oz water bottles with me on rides which tend to increase my output>>

      Wow, dude, that sounds like overdoing it a little don't you think? Every day you do this. No wonder you are retaining so much fluids. I'm sure you don't sweat all that fluid out riding your bike that far. I'm sure it helps though. I've noticed that when I sweat a lot like working in my yard, I do develop less urine.

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    • Posted

      Keith,

      If you drink a lot of coffee and then stop you will likely get a severe caffeine withdrawal headache that can last for a long time. I used to drink a lot of Coca Cola and when I went off, it hit me hard. It's the same for me with chocolate. Maybe this isn't addiction but......My point was and is that caffeine is a bladder irritant, so if you can wean yourself off of it you might find it helps some of your issues...might be worth the experiment.

      Tom

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    • Posted

      ****Wow, dude, that sounds like overdoing it a little don't you think?

      Yeah, maybe, but have experienced dehydration in severe heat and it's no fun. I only empty both 24 oz bottles when I sweat a lot...otherwise one bottle will suffice. Normally my PVRs aren't too high after my bike rides.

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  • Posted

    Please do NOT increase your dos of alfuzosin !! I've been taking it for 15 years now and while it still helps me its effectiveness has dropped. BUT it is very dangerous to increase the dose. You could try one of the 5-alpha reductase inhibitors like Avodart but it also wears off after a few years and has side effects but it will give you time to explore other options.

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  • Posted

    I have had BPH for 40 years. I have all the standard discomfort and inconvenience that goes with the condition. But I have learned to tolerate it. Least of all, I have no appreciable urine retention as the uro measures it on annual visits. So am I concerned about damage to bladder muscles? I guess not.

    It would seem easy for one's imagination to run wild once confronted with excessive multiple daily reminders of the need to void. But I am left to trust the doc's opinion that -- short of invasive procedure -- I may be stabilized, as he claims I am, indefinitely. I can't bring myself to self-cath or undergo TURP. AndI must have the most sensitive urethra on the planet. The few times I have had it probed with metal or tube thingies have been true torture. Pain off the charts. So...I push on and tolerate the hassle of pee breaks in direct proportion to the volume of fluids I consume.

    But again, my uro says I may well tolerate this status quo for the rest of my days. I am an otherwise relatively healthy 73. I do take 25mgs of Alfuzosin daily with a meal. If I miss, it is as if the tunnel has shut completely. I thank my stars for that drug -- my daily "friend" for the last 5 or so years.

    Good luck.

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  • Posted

    Correction: I have had BPH for 33 years. Since age 40. Just keepin' it honest 😉

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  • Posted

    First - not a good idea to change the dose of any drug without checking with your doctor first. From what I've read, more than the usual dose can bring side effects in quite a bit.

    BPH and retention can and does cause bladder damage. it's hard to tell from your post how bad your situation is, only testing can determine that - but here are some general thoughts.

    1. If you're straining and/or having regular retention events, you should learn to self cath and get a catheter prescription. Your current uro might facilitate this and its a great way to stop any further bladder damage and possibly reverse some of it. Depending on how bad your symptoms are, you may just need to cath occasionally - or, if its usually hard to pee and you retain a lot, it might make sense to make it a regular thing. Once you get the hang of it, its pretty easy to hide the catheters and no one has to know.

    2. You need to get a full work up - scope and urodynamics test to see how much bladder function you have, the extent of the blockage and what type. Only then, can a uro make an informed recommendation for a procedure.

    3. You don't have to do a TURP . There are plenty of procedures that don't require anesthesia with very low to virtually no chance of side effects. Which one might be best depends on the results of those tests. Enlarged median lobes rule out some things (Urolift/PAE) but there are other less invasive options than TURP that work well and don't preclude more extensive things (like TURP) if for some reason they don't work.

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  • Posted

    Johnny,

    The symptoms you describe indicate that your prostate is growing and blocking urine flow at an increasing rate, so it's time to get treatment. If you get a TURP make sure it's a bipolar or plasma button TURP and not the older style monopolar TURP. You could also look at other procedures, such as Greenlight. Some here have had REZUM with mixed results, same for Urolift.

    Tom

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    • Posted

      Don't use the anecdotes in this group to determine what procedure is best. A good urologist can tell you what the numbers actually are. This group is a highly skewed, not scientific and random look at these procedures. Most come for advice or because they had a problem with a procedure. People that have something done and it works as promised generally don't come here to tell people.

      This group is great for learning options and pitfalls - not for determining what procedures work and which ones don't.

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    • Posted

      oldbuzzard,

      I have been on this forum for many years and read all the posts and have been researching BPH and PCa procedures for almost 10 years. The "anecdotes" in this group have been a very valuable source of information from actual men who have had the various procedures, not just a statistic in a study. In particular, the details of all of the side effects and recovery issues are invaluable sources of information. It's not enough to just look at stats and say that a particular procedure works in X percent of cases - I want to know what happens when the procedures don't work or partially work and what the real life experiences of the patients has been.

      Tom

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    • Posted

      Tom86211, I ditto those comments, I am rather new to this forum...within the past year, but have had BPH since about 2003, but didn't know it was BPH until about 2018. I am in Northern California and my Uro only does TURP and UroLift. At present I take Flomax (Tamusolisn) (sp?) 0.4 mg. Once a day. My have urgency/frequency issues. Up usually 1-2x per night.

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    • Posted

      I'm totally with you on that. This forum is great for learning the range of things that can happen. What it isn't is a statistical study of outcomes - using this forum as a result predicter would be a mistake. The stats will tell you what the odds are of this and that. This forum will tell you what can happen outside the lines and what to expect even inside them. Lots of docs either don't know or don't bother to tell.

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    • Posted

      Actually, I am also in No. Calif and the various uros have their own particular specialties. Kaiser does PAE in Oakland but not Sacramento. Pacific Urology does many procedures in Walnut Creek. UCSF is a top rated hospital with some highly qualified doctors. There are a few urologists near Stanford University that do some of the procedures, but it really takes some research to find what you are looking for here - I know, I've gone through this drill. Actually, this may also be the case elsewhere in the country, this forum has been very helpful at recommending good urologists in various parts of the country.

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