Prostate remnants in urine after treatment

When I had GL laser in 2004 and years later Thulium/Holmium the little irrigation needed was done in the operating theatre and a catheter in my case was left in overnight. A friend who had GL did not even have a catheter when he left hospital about three hours later to go back to his hotel for the night. Laser hardly leaves any debris as it smooths over the surfaces. You do later pass a few blood clots and scabs. In my case very few.

Do Uros let patients have the option to do cic instead of having such a catheter put in? I know that they have to go through the urethra to get to the prostate to trim it, burn it, cut it, steam it; in order to cut away part of the prostate. So is the urethra still too tender to allow inserting a self-cathing device for a few weeks?

The purpose of the post-op catheter is to make sure all the "debris" from the operation is flushed out of the bladder. There is continuous flow of saline into and out of the bladder for many hours (17 in my case.) I can't imagine a urologist not following this procedure. I did not even notice the catheter except for an occasional bladder spasm which made me feel like I had to pee. When it was removed it stung for a couple seconds. Not a big deal.

Hi keith42667,

My catheter was fitted while I was still under a spinal block and also sedated. Given that I was irrigated for 30 hours with the first 24 hours at around 2 litres of saline per hour I wouldn't think that CIC would be adequate. My catheter was spigotted after 30 hours (the saline drip was shut off and the valve plugged) and was removed 12 hours afterwards. Op was 10am Monday, catheter was spigotted 6pm Tuesday and removed 6am Wednesday. I was discharged Wednesday afternoon and was home 5pm.

I gather they can send you home with a catheter if they feel there is too much bleeding but that catheter has a tap rather than a bag and is kept in for two weeks to allow the wound to settle down.

As far as I know here in the UK CIC, known here as ISC - intermittent self catheterization, would only be used before surgery or after the patient has fully recovered from the surgery.

Which procedure did you have that required 17 hours of flushing out?

Grunthos, thank you for your information. The valve I was talking about may not be a valve at all but something has to close to allow semen to flow out the penis instead of up into the bladder. Turp usually does damage that valve ( or whatever it is) and therefore retrograde ejaculation and urinating pieces of prostate is likely with that procedure However, procedures like PAE or rezum generally don't damage that valve ( or whatever it is) and yet guys are saying they are urinating pieces of prostate after those procedures. If they were ejaculating those pieces I could understand that but they're peeing them out. That's the part I just can't understand. How do pieces of prostate end up in the urine stream after a PAE or Rezum?

I had a bipolar TURP that started with a loop electrode and finished with a plasma button (there's a very detailed post titled "My TURP, part 1".) My doctor leaves the catheter in overnight (the procedure ended about 3 pm) for continuous bladder irrigation (they emptied 1000-1300cc from the bag every 50-60 minutes). Catheter was removed at 8:30 the following morning and I was able to pee (although slowly and not very much) so he discharged me around noon.

Grunthos,

If you were irrigated with a saline solution for 30 hours I would imagine that some of the sodium would be absorbed into your system and might result in increased blood pressure, tissue swelling and possible headaches. Anytime I have had too much salt or been exposed to a saline drip some of that sodium remains in my system for several days. My bodyweight increases by a couple of pounds and doesn't go down until the sodium is flushed out. Also, I get bad headaches after ingesting too much sodium. Did you experience any side effects from the saline/sodium?

Tom

He should Google TUR Syndrome but I believe it was Glycene not used now that mostly caused the problem .

How do pieces of prostate end up in the urine stream after a PAE or Rezum?

I Had a PAE and didn't have any blood let alone pieces of prostate in my urine, that's not how PAE works. It is true that there is some swelling that occurs, any interference with the prostate does that, but with no cutting or abrasion involved it is one of if not the least invasive intervention.

Hi tom86211,

Prior to the TURP I was given a leaflet that listed after-effects by their risk.

It says "Irrigating fluids getting into the bloodstream & causing confusion or heart problems" affects between 1 in 50 & 1 in 250 patients.

I didn't have any after-effects of that nature.

Regards

I had Rezum. I was given the option of a Foley or self cathing. I chose self cathing because I had a Foley before and didn't like it.

I self cathed once in the office as I was shown how to do it and once that night at home. After this, I was able to urinate enough to avoid any additional self cathing.

I did not experience any undue pain associated with the self cathing so I'd say that self cathing is a viable option after the Rezum procedure.

Bill

Pete,

With Rezum, small pin pricks go through the urethra to inject steam into the prostate. I don't think it is likely for parts of the prostate that die to come through these small holes into the urine stream. Especially since these small holes heal rapidly.

A PAE doesn't do anything to the urethra at all. The parts of the prostate that die due to a PAE are absorbed into the body and don't come out as chunks or pieces in urine.

Procedures like TURP or some sort of laser procedure obliterate the urethra where it passes through the prostate. This is necessary to gain access to, and remove, prostate material. This means that urine passing through the prostate can contain dead pieces of prostate, scabs, etc. until the urethra reforms.

In summary:

PAE - Impossible to have prostate debris in urine.

Rezum - Extremely unlikely to impossible to have prostate debris in urine.

Turp or laser procedures - You better be prepared to deal with prostate debris in urine because it's probably going to be there.

Disclaimer: I'm not a doctor. The above is my understanding of this issue after talking with my urologist and looking at schematics of the male urinary system.

Best wishes to all!

Bill

Prior to the TURP I was given a leaflet that listed after-effects by their risk.

It says "Irrigating fluids getting into the bloodstream & causing confusion or heart problems" affects between 1 in 50 & 1 in 250 patients.

I believe that statement applies to the monopolar TURP that uses glycine as the irrigating fluid causing TUR syndrome. I think most doctors are now doing bipolar TURP that uses saline so TUR syndrome is no longer a concern.

Hi lee56659,

That could be the case. All of my info before the TURP was in this leaflet. It didn't mention monopolar or bipolar, just a diathermy loop. I definitely had saline solution as the irrigation fluid though.

Regards

I believe the saline was called FlowFusor if that helps.

Thank you William USA. It didn't make sense to me that PAE or Rezum would result in prostate material being in the urine stream.

Thank you. Thats what I'd like to do if it becomes available here and covered by medicare. Right now I've been doing cic for about 2 years and am just happy with that.