There is no definitive agreed definition of Chronic urinary retention

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Long story short..I had turp and it didnt cure my chronic retention but did improve flow and lowered actual post void measures.

I now self cath (at moment) between one and three times every 24 hours, to make sure my bladder doesnt overfill.

What is overfill, I ask myself. When my bladder is holding (usually) more than 300 mls I can p**s easier and I believe it is the pressure build up that helps me void. I my have to accept that my bladder muscles are compromised and not working properly & I understand that.

So I believe it is partly bladder contraction and partly just physics ...in that gravity and sheer pressure within the bladder helps me void...

Over and over I hear the magic figure of 400 mls as being the maximum amount of urine that our bladders should hold ...where does this figure come from.

If anyone can point to a study or empirical evidence for this figure being the maximum healthy amount a mans bladder should hold comfortably, I would be grateful, rather than find out it turns out to be a another meme, with no real evidence to back this figure up as being realistic and true.

A Uro surgeon mentioned to me one time that the bladder has urine in it 99% of the time and we do not walk around with an empty bladder. So ergo it makes sense that we walk around with the bladder holding urine if not all the time, then most of the time without any health problems.

So this brings me back to what volume can we walk around with (maybe) over 400mls for an hour or so without any health problems.?

I know that backing urine up the kidneys is bad but it can literally take litres in our bladder and UUT to compromise our kidneys in the first place.

Im just throwing this out to see if anyone has opinions on what our bladder can actually cope with for years without real health problems....in the real world..:)

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  • Posted

    i have the same problem , the TURP only helped my flow but still retaining , i go all day without urinating the when i get home and relax its every hour into the bathroom to pee .

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    • Posted

      Kenneth 42676..how do you know you are retaining..do you self catheterise sometimes.?

      Old Buzzard..I often go all day and just pee normally..but during the night it seems my system goes to sleep and I need to catheterise either after peeing, or at times if sleepy I just catheterise without peeing normally

      .

      I just this minute had a stand up pee then catheterised out of curiosity..I cathed 220mls. IF I had sat down on the loo, I believe I could have voided another 100mls or so naturally..I do that sometimes...sitting voids much more..

      Motto..I think living as long as we do now might be called abnormal too 😃)

      Everything I read points to there being no absolute standard to describe what chronic retention is..I would hazard a guess that there are millions of men walking around having a pee and retaining over 100mls without any negative health issues though.?? They do not know because they feel ok....I just wonder when it does become a real issue.

      Mine became a real issue because I was retaining a huge amount..even then apart from feeling full and generally slow..I was still working and operating maybe at 80%..no kidney damage luckily though..!

      I guess I am just trying to get at some sort of real world figure where retention can be lived with & no real bad health issues..It is so easy to get hooked on figures and memes as the hold grail....Ive had the turp so now what...I tried catheterising five times a day "as advised"

      and a couple of times became alarmed when catheterising...nothing came out...I was so worried that I had created some sort of false passage or the tip of the catheter had gone AWOL...somewhere in there...!

      I realised I was catheterising way too much...So I started concentrating more on peeing normally and "cathing" less. Im sure its possible to cath regularly, and never ever rehab the bladder because it (the bladder) just doesnt need to "work"

      I personally am trying to get to a point where I stop being overly concerned about "some" retention on a long term basis...what that "some " figure is what interests me ...

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    • Posted

      For me standing up is more effective than sitting down, BUT, taking a shower wins hands down.

      I need to look up what catheterising means exactly. I think I can probably guess...

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  • Posted

    There is a sort of accepted standard of anything over 100 ml after voiding is considered retention - although many docs say you can go a bit above that and not need any intervention. As for how much you can hold safely, 400 is about the limit. Holding more will stretch and damage your bladder, which it sounds like happened to you after too many years of retention.

    Often this improves with time - you might want to measure how much you retain at different levels. Anything 100 or less is fine. If none get you there, consider self cathing more and on a regular schedule. There are many on this forum who rehabbed their bladders that way and got to something like normal function after time. For sure, don't risk further stretching, which at this point would be the worst thing you could do.

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  • Posted

    GInAndPlatnic46,

    I first heard the number 400mL , as a max to hold from Jimjames, 1.5 years ago. He started several discissions on this site about self cath, and was a source of information for many. I'm not sure where he got 400 from, but it seems about right to me. It may also depend on your size, larger people may have a bigger bladder and be able to hold more.

    One problem with too much retention is that the old urine mixes with new and you may hold too much old urine which will make you prone to UTIs. Of course you also want to avoid stretching the bladder. The bladder can also become trabeculated and have tough bands of muscle on the walls, causing the bladder to not function well. I don't know if voluntary straining causes trabeculation or just the involuntary action of the bladder muscles.

    If you take 0.4mg dose of Flomax, it may help you get out more, retain less, so you can use the catheter less. Some people also take a double dose, 0.8mgs .

    Hope this helps,

    Thomas

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  • Posted

    I have been self cathing for 2 years. Before starting, I was retaining over 1.5 liters before I would void a small amount. I never strained to pee, and my bladder became trabeculated, so I don't straining caused trabeculation. I drain 400 - 600 ml when I cath first thing in the morning - sometimes more. At other times, I usually drain 200 - 400 ml. I can usually tell if I have over 600 ml in my bladder, and I will go ahead and empty my bladder. I have not had a natural void since I started CIC, and I have not had surgery. At this time, I am not convinced surgery would help.

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    • Posted

      Thank you for your side of the story Pluff. How many times a day do you cath & do you feel it stops you from doing things you used to do or does it fit in with your life style.

      I seem to be getting into a routine of cathing twice in 24 hours, usually during nigh time hours...this disturbs my sleep routine, even though it doesnt take long to do.

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    • Posted

      No, I'm saying that I don't think my trabeculation was the result of straining to pee. It was probably the result of the retention volume. I always tried to relax when I was still urinating naturally. I had flow issues for a least 10 years before I started cathing. My flow progressively became worse. I took Flowmax for about a year, and it helped for a little while. I'm not sure how you distinguish between straining and pushing. I don't know if there is a medical distinction. I just never tried to squeeze out urine when I was trying to pee.

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    • Posted

      I cath 4 times per day, and occasionally 5. My usual schedule is when I first get up in the morning, around Noon, around 6:00 P.M., and right before I go to bed (around 11:00 P.M.). CIC has definitely improved my quality of life. I do not often wake up at night anymore with the urge to pee. Before, I would get up several times per night and avoided liquids at night. When I did urinate, it took about 2 minutes standing in front of the toilet to void about half a urine sample cup. I didn't realize then that I was retaining 1.5 liters. Often, during the day, I would have to go several times in an hour. When the sudden urge came on, I needed to find a bathroom right away. When I left the house, I worried about being close to a restroom when the urge hit. I no longer have those concerns. I have a small travel kit I carry in the car or on a plane. The only downside is that I have to have enough luggage space to carry my supplies when traveling.

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    • Posted

      If you haven't, you should get scoped and see if you have a significant obstruction. Many who can't pee at all have gotten reasonably good function back after a prostate procedure, when there was a significant block. Usually, bladders don't fail on their own, so an enlarged prostate could well have been what set all of this off. Fix that and your bladder might well rehab enough to ditch the cath. Many on this forum have had that experience.

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    • Posted

      Been scoped 2 or 3 times in the last couple of years by my uro. Had a urodynamics test at the regional teaching hospital a couple of years ago. Diagnosis was a neurogenic bladder. Still hoping for improvement. My uro tells me the body wants to heal itself.

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    • Posted

      I think you're taking the right approach - I had two procedures aimed at solving my chronic retention problem (urolift & BNI) & neither worked. I have now been recommended to go down the TURP route but three urologists I have spoken to say there is no guarantee that will solve the problem. In the meantime I'll continue with CIC.

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