Retention - Bipolar Vaporization

First of all, I am so glad I found this forum! I really didn't know what to do next and what my options were. Was looking at getting a second opinion but I need to know what questions to ask and know more myself. I think for me the next step is to have the 3T MRI done so I know more about what's going on down there. My URO first told me there was not obstruction, then yes, then it's my bladder and the Bipolar Vaporization would treat both. Maybe he is now saying there's an obstruction for insurance reasons? Anyway, I will continue to CIC until I learn more but I am already leaning toward the very expensive FLA. It's a 2 hour flight to Houston which is not too bad. I definitely am not doing TURP until I've tried FLA or Urolift or Rezum. And here's a question.. You mentioned self cathing 6x down to 2-3x day. I have just been doing it 2x per day, morning and after work for convenience.  Both morning and night are around 500-600 ML unless I have a few beers. How do you know if you should self cathing more?

Rule of thumb is you don't want to carry around more than 400ml in your bladder at any one time. That would be the sum of your cath volume plus any natural void just preceding it. If that sum is over 400ml, then increase the number of times you cath a day, otherwise you will keep the bladder stretched. I started 6x/day and four years later I only have to cath once or twice a week. If CIC isn't too inconvenient, maybe give it a few months to see if you make some progress. Have you had urodynamic testing yet? I wouldn't consider FLA (or any procedure) without urodynamics. Also, you should know that we're only aware here of about a dozen cases of FLA performed by Dr. K. I'd say the results were similar to Rezum and Urolofit which is mixed. While there have been no cases of retro ejaculation with FLA, you should know that there has been one case of erectile dysfunction that was corrected with Viagra. Personally, I'd like to see more cases and if not a peer reviewed trial, I'd like to see at least the results of Dr. K's own trial published before I'd jump in. YMMV

Jim

500-600ml is to much. You want to keep your PVR (post void residual) which equals your NV natural void plus CIC volume. I would add at least one more self cath a day.

What I do is CIC before bed, then around 5am. When the PVR sometimes gets up to the 500-600ml range and then I'll do another 2 about every 8 hours that day and the next. If its 400ml or less then I just do one more during the afternoon.

The 3T MRI is a good idea, I had one last March and it didn't detect any obstruction I'm scheduled for just an ultrasound of the bladder and kidneys next month to monitor things.

Good luck with whatever you choose and keep asking questions

@jw: You want to keep your PVR (post void residual) which equals your NV natural void plus CIC volume.

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NV plus a following CIC equals total bladder volume. PVR is what's left in the bladder after you void. Two different things. Keeping total bladder volume under 400ml is the key. PVR will vary depending on how well you are able to empty.

Jim

That is a good question.  The thing that makes cic kind of tricky for me (I imagine most of us with severe urinary retention) is that we don't have any feeling that there is 400 - to 600 ml in the bladder.  In my 20s if I was holding that much I'd be seeing waves in my eyeballs.  For awhile I got urgency and high frequency but after awhile the feeling would just dissolve away... I knew I was getting in trouble.  I didn't know I could be holding that much urine and not feel it until I got a UTI and got sent to the urologist.  So I have to kind of use the clock and my improving urges.  I've been doing cic about 5 mo. now.

Jim

I don't void naturally unless I am at the 1000 ml level. thought there was no problems until i had an infection. I did have the urodynamic test that led to the doc recommending turp. I guess I need to get more info on the results of my test as he just said theres some function but the turp will make it easier to empty the bladder. they kept calling me to schedule the surgery the next week but I decided to wait. Not crazy about self cath but seems as though others like you did that for a while. Thought someone posted that they got an infection from self cath, maybe during sex? Any suggestions on how to prevent an infection? Again, only been doing this 2x a day for 2 weeks. And what question do I need to ask uro about my urodynamic test to confirm how bad it is?

Tom

Cleanliness is one of the keys to avoiding UTIs. Hydrophilic catheters are supposed to be better, since you don't touch them. I use regular catheters, so I have to apply lubricant.  Knock on wood, but I haven't had a UTI in 7 months. I have read that cranberry juice can be good. Try different catheters. I find some are easier to insert than others

You want to ask for the urodynamic report and then go over with him anything you don't understand or feel free to post here for mostly unprofessional but occasionally insightful comments

Yes you can get a UTI from CIC, but you can get more UTIs from carrying around a lot of stale urine without CIC. I averaged 1-2 UTI's a year prior to CIC, and now I get around 1 UTI a year. Some here get no UTIs wiith CIC, some get more. Technique wise, try a hydrohilic caheter and read up about the no-touch "dive bomb" technique in the self cath threads here. But see how it goes, maybe you will be one of those who doesn't get UTIs.

Jim

Sounds like you're making progress with some sensation now. 500-600 is too much to be carrying around so I would cath via schedule rather than urge. Set schedule so that you're not carrying around more than 400ml. Your bladder will decompress more and hopefully you will start feeling the urge at lower volumes. Also when you cath, try pushing out gently from time to time, as if to simulate a natural void and/or do what you're doing which is attempting to void prior to CIC. You want to keep the detrussor muscles exercised.

Jim

I only have that much volume in the morning, and not every morning.  Since I now sleep through the night, I go 7 - 8 hours from my last cath before going to bed to my morning one.  I sometimes wake up feeling a slight urge to urinate.  I try for a natural void, but nothing comes out, even though it may feel like I am urinating.  Sometimes I get the sensation of urinating when cathing.  I don't measure every void, but I usually mentally time the amount of time it takes to empty my bladder.  This gives me a good idea on volume.  I am on a regular cathing schedule, and most voids are in the 250ml to 350ml range.  My urologist performed a cystoscopy last week and said my bladder is still tribeculated.

My bladder is still trabeculated and probably always will be, but I can empty down to 100ml and sometimes zero, so don't let that bother you. It's like an old car, it will always be old but if you take care of it then it can still run fine.

So if I understand it correctly, you only feel the urge to urinate in the morning when you're at 500-600ml. That makes sense.

Not to contradict myself, but you might try a one off experiment and instead of voiding in the morning when ou're at 500-600ml, maybe hold off another hour or so to let the pressure build up. Then try a natural void. Again, this would be a one or two time experiment, and not something on a regular basis. On a regular basis, again, best to keep the bladder volumes on the low side for bladder rehab.

Jim

Could you give just a layman's explaination of trabeculated?  Is that just a fancy word for "stretched out of shape".   If it also includes loss of feeling I would beleive it.  Its not that the bladder is stretched and can hold more therefore no warning to urinate; i.e. needing to empty. Its more than that.  If my rehabilitation goes in the reverse order that I got into this mess, there are a few stages that I recall I went through when I put off going.  I'm a lot like Pluffmud especially when it comes to nighttime & morning.  Most of the time I have a slight urge when I get out of bed, but can't produce anything; then the feeling goes completely away.  It can be hours before I start feeling and urge again.  Then when I do, sometimes they come fast and I have two 450 voids (NV & Cath) within about two hours.  I have to mention the role of black coffee, pretty strong,  I drink about 4 cups within the first few hours awake and often don't eat breakfast.   

A normal bladder is smooth. A trabeculated bladder is thickened and has kind of lines running across it. Bladder's get thickened (trabeculated) because of working too hard over the years to push the urine out, usually because of an obstruction. Go to google "images" and you can see what a trabeculated bladder looks like. I believe trabeculation is independent of a stretched bladder, but they tend to go together, again because of the straining and increased pressure needed to void. As the bladder stretches, the nerve impulses that signal us to urinate tend to be delayed or in extreme cases, stop signaling completely that the bladder needs to be emptied. The bladder is now considered flacid or even atonic. Urologists are more into "fixing" than rehabing, but a flaccid bladder can be rehabbed by decompressing it either by using a Foley or a program of self catherization. To what extent a bladder can be rehabbed depends on the starting point as well as the unique characteristics of an individual person. Four years ago my bladder was for all purposes flaccid and dysfunctional. Today, I empty well and only need to self cath once or twice a week. It was a gradual process but over time the urge to urinate came back and progressively at lower volumes. When I started I was holding up to 2 liters in my bladder. Today, I usually feel the urge at 400ml or less. Coffee can work both ways. If you want to experiment, stop coffee for a month and see if things get better or worse. Same with alchohol.

Jim

Just wanted to add that as the bladder gets stronger through rehab, the obstruction, while it doesn't go away, often becomes less of a problem. Urologists, however, because they are not rehab oriented, will suggest a surgery or procedure before that point is reached. The will tell you that removing the obstruction will make it easier to empty. This might be true, but equally true is that the same might be able to be accomplished by rehabbing the bladder. It takes two to tango, and with voiding, those two are the bladder and the prostate. If one is damaged/overgrown, the other can compensate to a degree. Sometimes just fixing one of the two is enough. Sometimes you have to work on both. Sometimes things are too far gone. In my case, I just had to work on my bladder to get things acceptable.

Jim

I just received an email from my uro regarding my urodynamic results and all he provided was that I had a weak bladder contraction and the TURP would have the best success rate of opening up my prostate over the Urolift or Rezum. However, he went on to say that there is a possibility that I will be able to unriate after the Urolift.

I am going to try and cath more often to try and get the bladder rehabbed based on your comments Jim, can't really hurt. And it will give me time to continue to so the research on Urolift, Rezum and FLA. Thanks Jim!

Tom

I have thought about that, but given that I had to exceed 1.5L before a natural void, I am not convinced it would help.  At one time before I started CIC, the uro emptied my bladder with a cathter, and it was a day before I had to go again.  Just to clarify, I am not at 500-600 every morning.  However, I don't worry about when I drink liquids anymore.  Whereas, in the past, I avoided liquids at night.

I am hoping my bladder regains some function.  My urologist says the body tries to heal itself.  If not, I am prepared to continue self cathing.

I drink 2 - 3 cups of coffee per day - in the morning.  I don't drink much alcohol.  On average, 2 - 3 beers per week.

Recently, I have found a bowel movement will also trigger the urge to urinate, even if I have cathed an hour or so before.

Seems as though I have similar issues except my Urologist does not give me the hope that my bladder can regain it's functions. Again, he was ready to do TURP surgery last week after the urodynamic test the week before.

 I have cut down to one cup of coffee and have limited my beer intake to the weekends so I don't have to self cath as much. I am going to AZ to golf this coming weekend so I know I will be drinking a lot. Not the best thing to do right now but this was planned months ago and will do what I need to do to get through this coming weekend.

Get some pocket catheters before your golf trip.  They are easy to carry around.  I use the Coloplast SpeediCath Flex Coude for that purpose.  I can carry them unobtrusively in my pants pocket.  They are hydrophilic and have a flexible, olive shaped tip.  They are not cheap, but very handy when I don't want to haul around my travel kit and will be out in public.

I have thought that too.  I'll see what my uro says about trying it next time I see him.

I'm not saying give it a try because I say so, but by now you're probably significantly more knowledgeable than your urologist about CIC and bladdder rehab, not that the bar they set is too high! In other words, think it over yourself cause your uro is just going to be taking a stab at this particular subject. On a personal note, if you read over my "easy/hard" threads on bladder rehab, I found that alternatively stressing and then resting the bladder gave quicker results than just resting.

Jim

Jim

<<Recently, I have found a bowel movement will also trigger the urge to urinate, even if I have cathed an hour or so before.>>

I've experienced this also even months before I began having complete retention.  Didn't realize I had to go so bad until after the bm.  I've noticed lately too that it works in reverse sometimes.  Not cathing on time - or rather after letting 350 or so accumulate -  I'll have a loose bm, then have to cath soon after.  Almost as if my overall body fluid level spiked all of sudden or something. 

Wow I'm surprised that you sometimes don't get an urge until 400.  I know you say that's maximum but still... You must not have much of a blockage if you can get out that much NV; assuming you can get down to very low PVR.  I know you say you only have to do it maybe once a week now.  Fantastic.  I guess even after all I've read from you that I have never heard you talk much about your BPH.  I know you took the drugs for awhile including Cialis.  I would like to try that but I'm too cheap.  Can't justify that much every month.  So all I'm doing is taking a natural OTC prostate formula that I got at Costco.  Did you have surgery ever?

Jim

My natural voids have been as high as 400ml, but the usual NV is 250-300ml with a PVR around 100-150. However, if I second void I can then get that down to below 50ml, sometimes zero. Depends on the time of the day, etc. In an event, I'm emptying fully at least once a day and most of the time not carrying more than 400ml, so I'm pretty happy.

Briefly, four years ago my bladder became for all practical purposes dysfunctional and I was in near acute retention repeatedly from a combination of obstruction and flaccid bladder. My prostate certainly hasn't gotten smaller so obstruction is the same (or more) but the difference is that my bladder now functions signifiantly better. Just because they call it BPH/LUTS doesn't mean that luts is entirely caused by BPH. In fact, BPH may not even be the primary cause. Thing is that urologists don't have a surgical tool bag for the bladder so they work on the prostate. That leaves bladder rehab mostly up to a motivated patient. Never had a surgery. Tried Daily Cialis as part of my "on/off" CIC strategy program but haven't taken it for many months.

Jim

Ken, I would agree and I asked my uro about it. heres the comment from my uro..."I don't feel Rezum has any significant advantages over Urolift in your case. Urolift will not open the prostate as much as a TURP so therefore the success rate will not be as high though there is a possibility you will be able to urinate have Urolift"

After reading all the comments on this site over the past several days, it has made me wonder about my own situation. About a year ago, I had an ultrasound on my bladder and prostate which revealed the following:  bladder capacity? 318 ml; prostate 55 cc; PVR 93 ml. My situation seems pretty mild compared to many others on this site and yet I am up 3 to 4 times during the night and urinate frequently during the day. My uro said I had bladder, sleep, and prostate issues and neither drugs nor surgery was likely to help much. I do drink a lot of fluids during the day but taper off by mid-afternoon (a glass of wine and a small cup of decaf with dinner). I try not to delay voiding which  is usually between 100-300 ml. I usually have no trouble urinating unless I hold it too long. It just seems odd to me that my condition seems quite mild and yet I have the same problems as others who seem to have a much more severe condition. I have some concerns about acute retention when I'm travelling. I suppose cathing is an option but so far I haven't had to do it.  

I just read trial from the UK and 17 other state's that were done from 2009 to 2016.  It was for Urolift, Turp and Holep.  The said that the Urolift was only a little behind the other 2 and the results between Urolift and Turp were similar.  Which I find very good.  We have had men on here That have had the Rezum procedure that wish they would have waited.  What did you doctor tell you about sexual side effects and retro.  I bet it told you it rarely happens they say about 4 %.  Well it is about 10 to 20 %  Urolift 0 %   Here is something that I read in the trial.  This is on any procedure that causes sexual effects.  It stated that the committee accepted that the damage to sexual function is regarded as a inevitable consequence.  In plane words they can care less.  The Urolift does the same as any of the other procedures.  All they are doing is making a tunnel.  The urolift does not do any cutting so it does not damage anything else in the area. It also heal fast 4 weeks and under.  Rezum can take up to 6 month if it works and it may leave you with retro.  Asked Todd86639 how happy he is with his.......But it is up to what ever you have because you are the one that will have to deal with the side effects not the doctor he just moves on to the next patient.  So I wish you will and good luck.   Ken