Turp operation or laser ?or leave alone?

Hi Bill,

If your bladder is truly emptying completly at night, then it's possible that the reason for getting up at night is not related to a prostatic obstruction. If that is the case, TURP, Button TURP, or any other prostate reduction procedure will not help.

In addition to another bladder scan at your urologists, try keeping a simple void log for a week or so.  Just void into a marked plastic beaker and write down the time and amount of each void. This will help determing not only how much you're voiding each time, but also the per cents of your day void volume versus night void volume.

If your night time void volume is over 40% of your total 24 hour void volume, then it could be age related nocturia caused by a host of things. And again, if that's the case a TURP may not be the answer.

Investigate first, think about surgery only after. 

Jim

It might sounds funny but you might drink too much water. Water and liquids are good for you but drinking too much water can be bad for youre kidneys and it will make you to want to urinate and drink water too often. I went to a internist who told me to reduce all my liquids to 2 litres a day and all my problems ended. The problem was that I became thirsty because I was drinking too much water.

Hi Wally,

Have you addressed this to me by mistake? I drink under 2 liters a day.

But you bring up an interesting point regarding over hydration. A lot of people don't realize that thirst can be a sympton of both dehydration and over hydration. If you're thirsty because of over hydration, you get into a spiral where you drink more and the condition gets worse. Happened to me a few years back and caught it/analyzed the problem with urine dip sticks. Sports drinks helped short term (adding solulites) and then as my thirst decreased I started drinking less.

But while interesting, if you have significant nocturia, even if you limit your fluids to 2 liters or under a day, you will still be getting up at night if a significant percentage of your urine output is while you're sleeping. It's just simple math. Fluid in basically equals fluid out and your bladder can only hold so much.

Jim

Jim

Bill look into Urolift That would do the same has the turp all there going to do is cut out a tunnel with the urolift they just pull it apart to make the tunnel.  But who is to say if you have anything done that your going to sleep better  There have been men on here that have had a turp or GL and still get up 4 or 5 times a night.  Sometime is is just habit  Why have surgery if you are emptying your bladder  ken 

Most people get some relief from getting up at night with a TURP, but I think most will still get up at night. I had two GL's and a TURP and I went from 5 or 6 times a night down to 3 or 4. The TURP is generally successful for curing retention and reducing the PVR to proper levels, but getting up at night could simply be due to a reduced capacity of the bladder due to muscularization after decades of bph. There's also the effect of age. Older women often get up once a night and they have no prostate. For the last few years I found that placing a couple of one liter plastic urinals in a basket by my bed allows me to sit on the edge of the bed in the dark, urinate in the urinal, and go right back to sleep. 

That and nocturia, more common as we get older. Nocturia is when the kidneys produce the lion's share of urine during the night instead of during the day. If this is the case, then TURP, GL or any other procedure will not help. It's just simple math. Even a healthy bladder will hold only so much before it will wake you up from sleep.

Jim

My bladder wakes me up when I have 200 to 300ml., depending on how soundly I am sleeping. Earlier in the night I wake up with less, in the middle of the night I sleep deeper and may wake up with more. Since I use two one liter urinals by my bed to go in the dark, In the morning I know I normally void from a liter to a liter and a half. Since I sleep for 8 to 8-1/2 hours this means I will wake up 3 or 4 times during the night (not counting going on rising). It's simple math. I have no obstruction and my PVR is just 32 mls. The TURP cured my retention but not getting up at night.

Hi Bob,

Assuming your PVR is only 32ml, then part of your issue could be OAB syndrome. 

You also say that you're voiding 1000-1500ml at night. If this is more than 40% of your 24 hour void total, then nocturia polyuria could be also part of the problem which requires a different treatment approach.

BTW when I was voiding 6 or more times a night, I also slept with urinals by my bed. Lately, for a number of reasons -- some of which I understand and some don't --  I only get up maybe once, very occasionally twice, and often sleep through the night. 

Jim

 

Bob,

Have you considered  a bladder retraining program so that your bladder may start holding more than 200-300 ml?

Jim

Glad you are doing so well Jim. I don't believe nocturia polyuria has any treatment. A couple of years ago I was going as much as 3 liters in a night, getting up 7 or 8 times or more. It just toned down by itself after about 9 months. Neither my urologist, or GP or kidney specialist or cardiologist had any suggestions for helping the polyuria nocturia. 

No guarantees but there are a number of strategies you can try for nocturia polyuria. The concept behind most of them is to change the percentage of daytime/night time urine production to favor day time urine production. But first, what's with the 3 liters at night? How much are you drinking each day? If you're drinking more than 6-8  eight ounce glasses of fluid each day, then that could be your problem right there.

Here's a few things to if you're still having issues with a normal fluid intake.

1. compression stockings during the day.

2. afternoon naps or resting with feet elevated.

3. get tested for sleep apnea

4. try a diuretic late morning or in the afternoon to stimulate daytime urine production. 

5. Go on a low salt/sodium or diet or try avoiding sodium during the day and just using it for dinner. 

6. Regular exercise

If all else fails, you can ask your doctor to get tested for ADH levels and consider hormone therapy. 

Jim

Is there any reason for your high liquid intake ? Hank

Hi Jim,

My suggestion is instead of opening a new thread on potato chips as you originally planned, perhaps you should open a new thread on nocturnal polyuria (high night time urine production). It seems to me that men with bph have this condition so often so it would benefit many. Hank

Hank,

Can't I do a thread on both?

Well, I think I did open a thread on nocturia polyuria at some point, but I will double check, and if I didn't, I agree it's a good topic for one and will do it.  But don't be surprised if you see a potato chip mention in it

Jim

I think my intake is normal, about 2 to 3 liters or so total for the day. Part of that gets used in digestion and respiration. Daytime urination is normal (4 or 5 times in 16 hours). More just comes out when I am sleeping.

Or I could just use the urinal 3 or 4 times a night and get back to sleep in less than a minute. As I said, the 3 liter nights was a couple of years ago and stopped on their own after about 9 months. No doctor or specialist had a clue. I do take a diuretic (lasix) around 4PM daily for my heart. I'm already on a low sodium diet.  I do walk, weather permitting, but I have not noticed that exercise or diet or liquid intake has any effect, and I would rather get up at night than feel thirsty. I am at a normal weight, and it stays within a 2lb. range. I have no edema. I already take 8 pills a day for heart, gout and to shrink my prostate. I also have leukemia. Of all my health issues, the polyuria is the least bothersome.

Bob,

If you're voiding 3 liters a day then your intake has to be more than 3 liters a day which is too much. 1.5 to 2 liters is enough. Unless, you have diabetes or diabetes insipidous, the latter is somewhat rare but can easily be tested for, even at home if so motivated.

Jim

Jim, thanks so much. I need to know more about what to do about all the potato chips that I have accumulated since you recommended them. I am sure others, including cartoonman though he'll probably will deny it unless under oath, will appreciate this. Hank

Ok, so sounds like you're covering most of the bases. You might still ask about being tested for the ADH hormone, but not sure if the side effect profile is worth the bother as you seemed to have adjusted. But it could give you an answer at least. What about getting tested for sleep apnea. I should talk because I have put that test off for two years now so do as I say, not as I do

Jim

I think 2 liters is normal, 3 is kind of high, especially for nocturnal polyuria sufferers. Hank

As I have written a couple of times, the 3 liters was a couple of years ago. My intake was normal but after voiding 3 liters, the next night I would void maybe 200ml and slept the night. At the time it seemed like my body was shedding water every other night. At that time I considered trying a pituitary drug that normalized the output for some people, but before I could get any doctor to prescribe it, the situation normalized by itself.

I have never known anyone tested for sleep apnea that didn't get told they had it, got the cpap machine and stopped using it. 

Hank,

Well, you can eat them straight, with vinegar or ketchup, or cheese,  mustard, mayo dip them, side dish them, spice them, soak them, great with sandwiches, burgers hot dogs and beer, compliments the sweetness of chocolate and ice cream, makes any picnic complete and every paper plate happy....you know, I'm not sure how I will live without them....

LOL

Gout is a good reason to have more liquid intake. Besides, as long as it does not bother your sleep, it is not a problem then. Hank

Waking up at night may not be related to the prostate.

Sleep apnea (one of the so-called silent killers) is a huge cause, and I recommend to have a sleep study if you are overweight/snore.

undiagnosed diabetes, heart issues, and drinking a lot also contribute.

Occasionally, behavioral modification (changes) can help; resting your legs up before you go to sleep (so called "couch potato time" allows some of the fluid to redistribute faster, and may allow you to urinate some of the fluid before going to bed.

JimJames you're amazing.  You helped me to understand that cathing long term is possible; not to mention all the thoughtful responses.  

I was having very bad overflow incontinence.  After a long time (my GP told me to just stop drinking coffee) I was finally referred to a Urologist when I found out I was retaining 1 2/3 liter of urine after very little NV.  While waiting for my appointment with the Urologist I was looking on line and found your posts.  This short time its been like a brotherly voice from beyond.  I was wondering how long I could just cath and watch & wait because I found out how much better I feel doing this 3 times a day.  But I figured this was out of the question because both my GP & my Urologist mentioned the Green LIght laser.  I have a pre-op appointment with my U in about a week so I am much better prepared now to talk to him and try to do what is best for my condition.  I have an enlarged prostate (I'm 65) and have been increasingly having difficulty peeing; I had prostititus about 4 months ago and my GP treated me with sulphameth and then Cipro.  That got rid of the UTI but I don't think it did a thing to shrink my prostate.  I guess my GP thought that it might.  They sent me in for an ultrasound on my bladder a few weeks ago and told me it was badly distended (almost up to my navel).  I wish I'd been introduced to cathing sooner because I'm hoping to not put this stress on my kidneys or bladder any more.  Cathing 3 times a day was producing about 450 ml so I'm  going to start doing 4 times.  Sharing your knowledge has been invaluable to me and I don't know how to thank you.  I'm sure there will be downsides to continuing self-cathing but for right now I'm not going to let this surgeon use his laser on me as long as I can get by for now.  Before I read anything from you or anyone else they had me cathing just until I could get into the Urologist but my incontinence has stopped completely now.  I have a couple of bags of depends I don't need now.

 

THat is great Keith.  doctors do not like to mention CIC they try to get you to have surgery.  Do CIC for as long as you want  Jim will help you  Ken

Hi Keith,

Welcome to the forum and thanks for the very nice words.

So glad you have found CIC helpful, like lots of men here, including myself. 

To start near the end of your post, there are very few downsides of CIC, and those are generally not serious and easily remedied. And that's not just short term, but longer term as well. I self cathed for three years, and many men much longer. In fact, in the SCI (spinal chord injury) community, many men and women self cath their entire life as their sole method of voiding.  As you mentioned, CIC done properly will protect both your kidneys and bladder as well as any successful surgery, be it TURP, GL -- and without any of the side effects. 

I mention all this because when you have your upcoming appointment with the uro, just keep in mind that you are now protected and any surgery such as GL (or some of the less invasive procedure)  is elective, and only when you're good and ready. Just keep in mind that most uro's re not as knowledgeable about CIC as you would expect, and their mindset is surgery when their drugs don't work. 

Without going into too much detail, it's a good idea to try and keep total bladder volumes under 400ml. The total bladder volume would be the sum of the CIC void plus any NV void just preceding it. You say your cath voids are around 450ml. What are the voids like just preceding that? What about the natural voids when you're not doing CIC? If you're not doing a void log, I suggest you write down the time and volume of every CIC and natural void for at least several days so you can plan an appropriate CIC schedule. 

Lots of info in the self cath threads on technique, catheter choice, overcoming problems, and bldder rehab strategies. The threads are getting long so sometimes info is hard to find, so just feel free to ask away.

Jim

 

Keith i forgot to tell you that i have a friend that has been CiC for over 20 years  She is almost 75 and has not stopped her from doing anything Ken

Yesterday I started 4 times a day rather than 3.  I think that will work for me.  After sleep for about 7 hours NV and cath was @ 380 and 6 hrs later @2:00 PM it was only about 340 or so.  Couldn't get any out at all pre-cath.  I tried for about a minute.  I have a bit of pain in my stomach and pelvic regions when I push.  I think if I have only 350 - 400 ml I can't get any to come out naturally.  Don't even feel like I need to go at all after 6 hours drinking water and coffee.

 

Did you say that you get UTIs about on average once a year?  Do you have to take anti-biotics for that?  Also, what did you do about your prostate?  Is that how you got the stretched out bladder in the first place?

I only treat symptomatic uti's, and they have averaged maybe once a year, when I self cathed. Before I self cathed, I got them more often. 

I haven't done anything about my prostate. My urologist 3 years ago wanted to do a TURP but I decided to self cath instead. My guess is that my bladder stretched for two reasons. First, an obstructive prostate, and second from years of "holding it in" during car rides, movies, sporting events, etc. The difference now, is that after a couple of years decompressing my bladder via CIC, I don't try and hold it in, but just heed nature's call. So far, so good. I stopped CIC over 5 months ago and everything is working pretty good, which again suggests that BPH/LUTS is not just an enlarged and obstructive prostate, but it's an enlarged and obstructive prostate that's not match for a weak bladder. Strenghten the bladder and it can be a different story.

Jim

I'm just so glad that your posts were out there.  I was delivering mail for about 4 hours during the day.  If I'd realized what I was doing to my bladder I would have voided when I even noticed it.  My route was in the country.  But I would drink coffee the whole time and wanted to get finished so I would hold it.  Also some 12 hour car trips in the last year.  Probably a lot of it is age also. But by the time the incontinence started I had developed a uti from the retention (I guess).  My GP's solution was to give me two rounds of antibiotics and it wasn't until after that; like a month later; he decided to order an ultrasound of my bladder.  I needed to be catheterized long, long before that.  

I'm now using just straight Coloplast FR14.  They seem to work fine although I had some bleeding at first.  It surpised me when I started using those that the flow would be very good; but when it quit it was sudden; not slowed; and it even felt like the catheter jerked a little; I always try moving it around or in or slowly out about an inch so I'm sure it got it all.  

 

Keith, you shouldn't have to push. If it doesn't come out on it's own just use the cath. It sounds like yu are doing well with the 4x a day routine. 

Hi Keith,

This may be a duplicate post but I can't seem to find the one previously.

Anyway, 380 and 340ml sounds fine. But I'm curious, if you're only self cathing 4 times a day, and your voids are each around 350ml, then your 24 hour urine output is only 1400ml. Is this correct, or am I missing something?

Jim

Keith,

I think "holding it in" and "rushing the job" is a national pastime for most men. We even brag about it when young, how long we can hold it. And then, we get older and pay the price!

Are you using the Speedicath version with the hydrophillic coating, or do you use an extermal lube? If not, you might try the Speedicath, as well as the Coude tip version. Also, when you feel comfortable, you could experiment dropping down a size to FR12. The urine will come out a little slower and you may not get that "jerk" at the end. The jerk could also be the catheter touching/sucking the bladder wall after the bladder has emptied. It's a good idea to push the catheter in an inch more after the urine starts to flow. And then when the flow starts  to slow down, ull it down slowly to empty the bladder from the bottom.

Jim 

Yes, I've been listening to advise and I ordered some of the speedicath to try.  If I end up with two boxes of these regular FR14 Coloplast straight end ones so be it.  But I'll likely use them because they work fast.  I have a little trouble pushing the 14 all the way in but not much trouble.  It feels like I reach an obstruction directly before I get to the bladder sphinter of a couple of inches.  In the beginning; about a month ago; I was getting some blood clots out about every third time.  But that has stopped now.  Yes, I do move the catheter around a bit after it stops especially when its sudden.   I thought then that the clots could have been causeing the suddent stop but now I've chalked it up to differences in catheters.  By pushing it in about an inch I got a lot more one time and another time by pulling it out just a bit; same thing.? 

The ones I now ordered to try are the 12 hydrophillic with coude tip.  The smaller the better if they work.  I had some FR12 samples of the ones that are bent in half in the package from coloplast.  I was using them OK but a couple of times when my bladder was really full the urine came out from around the outside of the catheter and got my hand wet so I thought I could use the 14.  

So when I hit the reply to JimJames button at the bottom of the form here; it only shows up to you?  That's one way and the other way is to go to the bottom of the page and hit the button that says reply to the discussion.  Is that correct?

No. The replys are public (show up to everyone) whether you reply to a specific person, or the original poster (botttom or top of page). The difference, other than the name after the ">" is the order they will appear in the thread. Beyond that, it's kinda confusing and I never fully understood the way threads are organized here.

Jim

 

The only way to reply privately to someone is through the private messaging system. To do that you click on the mailbox icon, under their name, and slightly to the left of the second line of copy in each post. 

Keith,

It's good to experiment with different caths and different sizes. In general, good to try a coude (bent) tip first if you have obstruction as they are designed to go around an enlarged prostate through a narrow urethra without getting caught or doing damage. Just remember, that with the exception of the new coude FLEX, the tip must be oriented properly when inserted. Very important. I can private message you a diagram if you want. The one that are "bent in half" from coloplast sound like the new FLEX coude. They don't need any special orientation before insertion. As a rule of thumb, use the smallest FR size catheter that works. But if the catheter is bending too much and/or not getting past the prostate and into the bladder, go up a FR size. You also should try going up if urine is coming out from outside the catheter. Lastly, you might end up using one FR size with one model catheter and another FR size with another model. Different catheter models, even from the same company, have different charteristics. Just be gentle and don't force things. You can reply to this or ask any other questions on CIC in one of the self catherization forums like here: 

https://patient.info/forums/discuss/self-catherization-issues-and-problems-552686

Jim