Second TURP
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Had TURP many years ago but old problems have returned.
Urologist has said I need TURP doing again and has placed me on waiting list. I have great difficulty peeing, doesn't completely void and dribbles when I put it away. Surgeon has offered to put a Foley Catheter in while I am awaiting surgery but as far as I can remember the Foley was only used following surgery. Should I agree to having this catheter inserted to relieve symptoms while I'm waiting?
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cartoonman peter30970
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Denknee peter30970
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cartoonman Denknee
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jimjames cartoonman
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I have been relatively successful in bladder rehabilitation, and now only have to cath after periods of inactivity such as sitting for long periods of time, napping, sleeping, itself. Other than that I can now empty my bladder down to under 50cc (and always under 150cc) almost all of the time.
Never know, but I think my success in part was at one point increasing my cath schedule to more than is generally recommended. The general recommedation is that if you cath more than 400cc, increase the schedule. I increased my cath schedule so that my total bladder volume never exceeded 400cc. By that I meant the total volume of my natural void plus whatever then came out with the catheter. So, while I probably only needed to self cath a couple of times a day by the conventional standard, I upped it to six times a day.
Of course, I can't be sure, but I think that doing that over many months speeded up my bladder rehabilitation by giving the bladder even more rest and less stretch.
At times, even now, I have gone back to this more agressive schedule when I feel my bladder has lost some tone.
Something you might want to try.
Jim
arlington cartoonman
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arlington jimjames
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jimjames arlington
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The idea behind bladder rehabilitation is to give it a vacation so to speak so it can regain some of its lost elasticity from being stretched out in many cases for many years.
My bladder was so stretched out prior to self catherization (CIC) that they drained 1500cc out of me after a natural void of around 400cc. So I was walking around with close to 2Liters of urine probably for some time.
Bladder rehabilitation is often used before operations like TURP both to see if they will be effective and to produce better results. What's the point of getting a TURP if you will have to CIC anyway?
The usual convention is about six weeks of a Foley. In my case I chose six weeks of CIC.
After six weeks of CIC I had a urodynamic study that showed I would probably have a sucessful TURP given the present state of my bladder which had been rehabilitated somewhat from the CIC due to the fact that I was emptying it on a regular basis so it was in a decompressed state a lot of the time as opposed to being stretched all of the time as it was before.
I decided to pass on the operation, however, and continue with CIC. I did ask a couple of urologists if I ever could rehabilitate my bladder to the extent that I could stop CIC and just urinate naturally with acceptable residuals and I got firm "no's" from all of them.
While I can't say at this point they were 100% wrong, I can't say they were 100% right. In fact, I'll say they were more wrong than right with me.
After about a year and a half of CIC, I noted significant improvement in my natural voiding. So much improvement that in the past few years there have been times where I have stopped CIC altogether for periods as long as 4 months. AND with very acceptable PVR's as measured by ultrasound in my urologist's office. Usually 50cc or less, which is better than most TURP results, according to my urologist.
Today, I only need to self catherize if I have been sedetary for some period of time. That could be lying down, taking a nap, or a middle of the night thing after sleeping. Not sure exactly why this is but I have heard other similar stories where urination is harder after being sedetary.
What I've found is that if I then walk around for 10-20 minutes, things go back to normal and I can get a good normal void. So, for some time, that was what I did, and during this time I did not self catherize.
Lately, I gave in to expediency, because walking around for 10-20 minutes (especially in the middle of the night) can be a bit tedious as opposed to CIC which takes me literally 2 minutes from start to finish without any pain or discomfort at all. Its really like brushing my teeth at this point.
How I got to this place defies the assumption by my (and many urologists) that bladder rehabilitation will peak in six months to a year. In other words, no progress after that. In my case, I continued to make progress beyond that time to the extent that the last couple of urologists I saw said they haven't seen anything like this type of rehabiliation in all their years practicing.
My guess is the reason they haven't seen it is because they don't prescribe it CIC very much long term, they just operate!
As to my approach to bladder rehabilitation, I simply upped the CIC game and increased the frequency of my catherizations more than I needed to based on current guidelines. Current guidelines say only increase the frequency if you cath 400cc or more. What many of the guidelines fail to take into acount is the urine that many can expel prior to CIC. So by the guidelines, I might only cath 300cc which means not to increase the cath frequency. BUT if I naturally voided 200cc prior to that, then in effect I was walking around with 500cc in my bladder keeping it in a somewhat stretched position.
I changed the frequency so I never carried around 400cc at any time. Again, the idea being that the more decompressed the bladder was the more chance it would have to regain elasticity.
Lots more, but that's the story in a nutshell. All our bladders and prostates are different so not sure this will work with everyone but I'm sure I'm not the only one who could rehab their bladder to this extent.
Jim
jimjames
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Probably better to direct any more on this topic over here: https://patient.info/forums/discuss/self-catherization-an-alternative-to-turp-greenlight-holep--336874
I will copy and paste my previous response there as well.
Jim
jimjames
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https://patient.info/forums/discuss/self-catherization-an-alternative-to-turp-greenlight-holep--336874?page=2&order=Oldest
arlington jimjames
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jimjames arlington
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So how much comes out when you cath? If you don't know, get a 500 ml (2 cup) plastic measuring cup and start a log. I think I was maxing out at 150cc for natural voids during my first year. Over the past couple of days, I did two 400cc natural voids. Personal bests!
Jim
arlington jimjames
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jimjames arlington
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Jim
cartoonman jimjames
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The challenge is, that my own body signals don't kick in until the bladder is more full than I'd like, usually more than 500cc retention. I am on a self-devised program of "rewarding" my bladder when I get the urge, by immediately voiding, such as it might be. Less is still better than "ignoring until I REALLY need to pee," I figure. I've been doing this only for three weeks; improvement will come slowly, I've accepted...
jimjames cartoonman
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Jim
cartoonman jimjames
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Now, it's just maintenance with the vague hope (I am still an optimist at 66! :-) ) that cathing will prevent back-up into the kidneys and provide some bladder rest.... :-P
arlington cartoonman
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arlington jimjames
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jimjames cartoonman
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Jim
jimjames
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Jim