PVR

Thanks Oldbuzzard

I have a weak bladder and BPH. I am hoping to get a procedure done eventually to remove the blockage. Meanwhile I am self cathing.

I appreciate you taking the time to reply

Dermot

Thanks Steve.

I have a weak bladder and BPH. I am hoping to get a procedure done eventually to remove the blockage. Meanwhile I am self cathing. If I am lucky I should be able to void a bit by myself after the blockage is removed.

May I ask if you are still self cathing to drain the 100 ml PVR?

How weak was your muscle?

I presume you had been stretching the bladder for a long time before you ended up with the acute retention of 2 litres?

Thanks

Dermot

dermot16441,

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I really don't need to self-cath anymore, but I am doing it 2 times a day to record my PVR's to track my bladder recovery. Also, I only get up 1 time to pee overnight if I am totally empty before I go to bed. Self-cathing to measure PVR's is a lot cheaper than buying an ultrasound scanner for several thousand dollars.

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My detrusor muscles were very weak when I flunked my urodynamics test in late-July 2018. After they took 2 liters of pee out of me in mid-January 2018, it was not until mid-April 2018 that I felt any sensation to pee. Now in mid-August 2019, I have a strong pee but I do not completely empty.

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Yes, I assume that I was stretching the bladder out for a while in order to hold 2 liters, but I don't know for how long. An ultrasound from 2 weeks earlier showed a 500 ml PVR but I could have been going up and down for a month or more and maybe had some other AUR episodes.

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By recording my PVR values everyday in Excel and then graphing the daily results and monthly averages, I can clearly see a pattern of improvement from a high of about 160 ml, to now about 100. I can also see an increase in frequency of PVR's under 100. Also 1st day values are higher than before-bed night values.

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So the bottom line for me is that my Rezum was successful in clearing the bladder outlet obstruction from BPH, but but due to bladder damage I cannot completely empty but over time, my PVR's are moving into the OK volumes which shows that my bladder is slowly recovery.

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I hope that this helps.

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Steve

Hi Steve

It sure does help. This forum is a great resource for information and support.

I would be hopeful of an improvement in flow after my procedure. I know it won't be great because,like you, I had the two litres on board before I was drained and I am voiding very little now on my own.

However, I could be a lot worse. There is some life left in the detrusor so I am hoping that I will be able to empty 50 or 60% of my bladder by myself after my operation. From there on I would hope to follow your pattern and get the PVR down bit by bit.

Dermot

Hi, Steve,

I'm also getting my PVR down a little bit at a time but am also battling some other issues. A few weeks ago I was diagnosed with a repeat

Spigelian Hernia (the lower horizontal branch of your colon bursts right out of you). It was shored up with chicken wire (just kidding again!) but this failed, A pelvic ultrasound was performed which confirmed that I was full of it so I'm booked in for a CAT-scan for tomorrow morning. However, yesterday when I performed the first of my three daily CICs I was surprised to find that my PVRs had dropped suddenly to well below 100 mls; needless to say, I was elated! But, calamity! An hour later I was peeing blood everywhere and I had developed a nasty pain in my left testicle! They very kindly booked me in for a Testicular Ultrasound immediately following my CAT-scan tomorrow.

I'll continue with this saga tomorrow when I have the hospital work-ups. I think I know what has happened but I want to get confirmation before broadcasting this information. Trust me, this information could be very important to those of you practicing CIC.

Warm regards, alan86734.

dermot16441,

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Two other thing that I do is "detrusor" exercises and suprapubic tapping.

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I do the detrusor exercises 2 times a day for about 30 minutes about every 5 minutes or so which consist of trying to pee for a count of about 200 with some bearing down to work the detrusor muscle. People with incontinence (the opposite of our problem) do Kegel exercises to strengthen their lower pelvic muscles to hold it in.

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This is combined with suprapublic tapping which consists of tapping to a count of about 200 over my bladder with 4 fingers held vertical which can stimulate the bladder to pee again. If I get good results from both, I continue beyond 200 until I cannot pee anymore. My urologist said "work your bladder" so this is the workout.

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Unlike the exercises that the physical therapist gave me to do for my 3 shoulder injuries (skiing is a dangerous sport), I cannot workout with weights and therabands for my bladder.

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So what procedure are you looking at doing? Oldbuzzard and I had Rezums and we are pleased with the results.

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Steve

Alan,

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I am sorry to hear about your sudden emergency. I suspect that the Spigelian Hernia may be pressing on your bladder. I don't know what the blood is about. I hope that all goes well tomorrow.

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Take care,

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Steve

Hi Steve

The exercises sound good and make perfect sense. I guess the idea is to put the detrusor under a little pressure,but not too much,to get it to build in strength.Resting it by CIC is also probably no harm.

My procedure will be TURP. I know that many on this forum are against it but,as far as I know Rezum is not available here (in Ireland) as yet.Our urologists are top class but it takes a while for new procedures to receive the green light from the Health Insurance companies.

I am happy to get a TURP despite all the reservations being expressed.

Thanks again

Dermot

Dermot,

I had a bipolar TURP four months ago and the operation was easy, and the recovery fairly quick and painless. The only irritant was having a Foley catheter in for three days. There are basically three types of TURP: the older style monopolar, the newer bipolar and plasma button. The bipolar and plasma button TURPs use a plasma button to cauterize the bleeding, so recovery is much faster. I was in and out of the hospital in 4.5 hours.

The primary objection to TURP on this forum seems to be retro - not an issue for me.

Hope all goes well for you,

Tom

Thanks Tom

It is very reassuring to hear that. I know my urologist is very competent so I have no worries on that front.

I have had the foley in the past when I have been in for chronic retention and for complicated UTIs. The foley is horrible but hopefully I will not have it for too long.

Once again, thank you, it is wonderful to get the support.

Dermot

What happened? Please update. Yes, I'm CIC'g so I'd like to know. Thanks.

Hi Motto and Other Followers,

I left you all on a cliff hanger; my apologies!

I had the CAT-scan and that revealed a small, as "in how long is a piece of string?", and a small benign cyst. A following testicular ultrasound minutes later revealed that my left epididymis was indeed inflamed.

This all started when I was evaluating two catheter versions, produced by different companies but marketed under the same brand name (those of you who need to know please PM me). Even though both were hydrophilics they still seem to have released a bacteriostat which my urethra reacted to negatively, so I rejected them. This irritation usually results from chlorohexidine added to the lubricant to prolong shelf life. The problem is that, in my case, I did not feel the irritation until about 30 minutes after the CIC session. As a result I was unfairly blaming myself for the bleeding, but then while evaluating a whole bunch of catheters the true culprit was identified.

In the particular case we are looking at here, my question was: Can something originating in the urethra find its way to the epididymis? The doctor I spoke to assured me that, although a long shot, this was entirely possible.

Now I'm into a ten-day course of Doxycycline Hyclate, one of the few antibiotics I'm allowed to take, and my well-being is improving by the hour!

Best wishes, alan86734

Hi, Motto,

The CAT-scan revealed a small hernia.

Regards, alan86734.

Hi Steve

Were you on any meds during 2018 while you were awaiting the procedure?

Were you able to void anything at all during that period between January 2018 and November?

I am on Combodart myself and it has reduced the enlarged prostate a bit. I can void a little bit when I have 450 ml or so in the bladder. This is a little bit of an improvement. In the beginning I would only void a little if I had over 500 ml in the bladder.

I also notice that I am recovering the signals/sensation to urinate. This was absent a few months ago when I was diagnosed first.

Dermot

Hi Dermot,

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During 2018 while I was waiting/deciding on the procedure, I was on Finasteride and Tamsulosin for about 10 months and I was not able to pee whatsoever at all. Both medications did not work which is the case for a significant obstruction.

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I had a significant obstruction, primarily due to an enlarged median lobe which bends or kinks the urethra resulting in a total blockage. Think of stepping on a garden hose (later lobe obstruction) vs. kinking the garden hose (median obstruction).

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It took me 3 months until I had my 1st sensation to pee again. This was usually at 190 ml when I self-cathed soon thereafter. I had a strong urge to pee at over 270 ml when I self-cathed soon thereafter and at 350 it was "urgently" very strong.

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Now, 8 months post-Rezum, in the last few weeks, my PVR's have dropped into the OK range for my age of under 100 ml for most days of the week. So bladder recover does happen but it is very slow...

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Steve

Thanks Steve

I appreciate you taking the time to reply. I am getting great hope from hearing your story because it sounds like we had a lot in common.

I am pleased with the way I have the ability to pee at lower volumes.

I feel that if the blockage was removed by TURP, it has to give me a better chance to empty a good lot more.

Dermot

You have evidently sustained bladder damage during your wait for the procedure. Before GL I was told that I was retaining 400 to 600 mls and was in danger of bladder damage but it fortunately didn't happen . Post GL I was fully voiding on the second day and my retention was described as minimal (25mls)

Steven,

Very sorry to hear about what you have been going through. I am now four months post TURP and my flow is improved, but the emptying of my bladder isn't as complete as I had hoped for - still takes me several tries in the bathroom before the urge to pee goes away. The main try empties most of the bladder, then subsequent tries empty the rest. The sensation of "got to pee" doesn't completely go away until my bladder is really empty, so I say that it's "hyper sensitive". The fact that it has taken you many months to get your bladder working again gives me hope that my bladder will eventually recover.

Tom

Tom,

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Thanks, but its not that big of a deal. The Rezum went like clockwork and the bladder recovery is slowly moving along. Before the Rezum, based on my urodynamics tests and cystoscopy, I knew that the bladder recovery could be a problem.

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If you need to take a few tries to empty, then try some suprapubic tapping where you tap over your bladder to stimulate it to continue peeing. It has worked quite well for me. I use 4 fingers held vertically and tap with the tips together.

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Steve

Interesting idea - will give it a try.

Thanks Derek

I had the damage done already with my months of chronic retention. I obviously stretched my detrusor muscle to the limit.

I am even surprised that the bladder is showing signs of recovery as I thought I had no chance.

The self-catheterization has been preventing further damage during the waiting period as it keeps the volumes down most of the time.

Hoping for the best

Dermot

I hope it goes well for you. Waiting time? You must be an NHS Patient. You can ask to be referred to an other hospital or Area Health Authority. I Asked to be as the Scottish hospital I attended did at that time only did TURP and I wanted GL that was being done at Newcastle.

Hi Derek

What I meant by waiting time was not that I was put in a queue. It is normal for urologists to put people on medication and self-catheterization for a period of time to observe how things might improve. In theory, the catheterization should prevent further stretching and damage to the bladder. In my case I would say there has been improvement during this time.

As regards procedure, there aren't many alternatives to TURP available in Ireland, as far as I can see.

I don't think the Urolift type of procedure would be any help to me. I need the cavitating type because I have a weak bladder , so the goal of any procedure would be to achieve an outcome where there is minimal obstruction.

Thank you for your reply. It is very encouraging to hear from others in the same boat.

Dermot

I think they do that as it is a cheaper option. Hospitals prescribe medications in the UK as it comes off the GP's budget not theirs. I'm surprised that you don't have a range of options in Ireland. Is there an option to be treated in other EU countries?

I did not like the idea of self cathing and would not do it.

From what I've seen here (US) it's not normal for Uros to suggest cathing. I had to ask for it and one Uro refused to write the script and the second one said sure.

So, here these Uros won't recommend it, won't even tell patients about it. I had to find out about it here on the message board. I suspect they don't want you to get any relief but want you to get an expensive procedure as quickly as possible.

But what sold me on the idea was the notion that I could naturally rehab my bladder, restore some function AND sleep through the night. I think it's criminal that these Uros won't even tell patients about it.