Urinary Retention
Posted , 9 users are following.
I have had urinary retention for a long while, a urinate alot but the urologist told me, I retain about 400 ml in bladder at all times. But I was functioning, until I fell a bruised my knee while weightlifting and broke a Baker's Cyst in my knee, My knee swelled really bad with extensive pain and I was sleeping alot for about 10 days , 12 hours a day, but took no pain medication. Than I noticed I could not have a bowel movement. So my physician told me to take Milk of Magnesia. Than I got very bad diarrhea and started to feel weak. So than finally the doctor took a blood test and found creatine level, bun were all elevated and my kidney were shutting down and they had to catherize me and approximately 3000ml of urine come out of me and more the next day or 2 days. Now I need surgery, he wants the greenlight. With greenlight or with Microwave do you always have retro ejaculation. Actually with the catherization, my kidney function is coming back, but why after the fall on the knee did everything do downhill and cannot figure it out. But anyway I guess it is greenlight immediately. My potassium blood level was very elevated also. It was very bad.
0 likes, 47 replies
jimjames mark23925
Posted
Hi Mark,
How are you urinating now? Are you on a Foley or doing natural voids? If the lattter what is your current retention?
I don't have a clear cut answer to why all of a sudden you went from retaining 450ml to 3000ml, but I do have a suggestion regarding Greenlight. It's a major operation with a significant chance of retro ejaculation, which you have expressed a concern about.
If you're not aware, there are newer, less invasive procedures now available that you may be a candidate for that will save your ejaculation. Among these procedures are PAE, Urolofit and Rezum. There are also two other even newer procedures that a couple of people here have had, namely FLA and iTend, although iTend is only in very limited trial.
One suggestion I think will serve you well now is self catherization. It will empty your bladder completely, protect your kidneys from any damage and basically give you the similar symptomatic relief from bph symptons as an operation.
It will also give you time to look into the less invasive procedures I mentioned before as well as rehabilitating your stretched bladder at least to the point where the doctors can have a better idea if an operation like Greenlight would even be successful. I mention this because if your bladder has become too stretched, it's possible that you could have Greenlight and still need a catheter to urinate. Did your doctor tell you this? Have you had any urodynamic studies done?
Anyway, lots of information on self catherization here, including personal stories like mine. I was told three years ago I needed a TURP operation an chose the self catherization option instead. I am very happy with my decision.
Jim
mark23925 jimjames
Posted
now I have spikes in blood pressure up to 180/100 in middle of night. Who knows what to do. Do not know what Rezum is and I think PAE would be hard now. Do not want retrograde ejaculation, but I want to live also. So what would you do now?
jimjames mark23925
Posted
Hi Mark,
I assume they have tried differrent catheters like a Coude tip, for example? Did they give you a reason why it is so difficult for you to be catherized? Is it something that they can fix with minimal side effects?
Self cath would be my first choice but if that is ruled out then I think I would at least temporarily ask for a suprapubic catheter with Flip-Flo valve. It would buy you time to look for surgical options while being significantly more comfortable than wearing a Foley. At night you would let the suprapubic drain into a bag for an uninterrupted night's sleep and during the day, you would use the Flip-Flo valve when the bladder is full so that you would not need to carry around a leg bag. Because they make a small incision in your lower abdomen for drainage, there is no tubing in your urethrea. The incidence of UTI's and infection is also smaller than with a Foley.
As to surgical options, iTind is probably out as it's in trial and has fairly rigid exclusion criteria. Your PVR would probably eliminate you right away but it couldn't hurt to call the trial coordinator and discuss. Focused Laser Ablation (FLA) is another new choice, and looks promising, but I think it's very new for BPH, so you would be one of the first. There are a number of posts on it here and one of the fellows I believe just had it done. Then there's PAE and Urolift. Best to be evaluated by someone who actually does the procedure as opposed to by someone who only does Green Light.
Lastly, there something called ejaculation preserving TURP. You can google it. Seems more common in Europe than here. From what I can understand, any uro can perform an ejaculation preserving TURP type operation, including Green Light, but it's just that most either are trained or inclined to do so. The trick then would be to find someone who has the expertise and is willing to do the operation while being careful to preserve the ejaculation function.
Jim
Greg123 mark23925
Posted
Hi Mark,
You should look into PAE. It sounds like that can help you enough where you can then be able to either naturally void more on your own, or at the very least self-cath which will save your bladder and kidneys. FYI some blood pressure meds can also cause you to urinate more frequently. That's why you seem to be retaining more urine in my opinion.
jimjames Greg123
Posted
Mark said: FYI some blood pressure meds can also cause you to urinate more frequently. That's why you seem to be retaining more urine in my opinion.
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Are you talking about diuretics? More frequent urination doesn't necessarily translate into retention, in fact it may even help retention by lowering the bladder volume where you feel the urge to urinate thus creating less of a load for weakened bladder muscles.
Jim
Greg123 jimjames
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Jim, I've read that blood pressure meds such as nifedipine (Procardia) can indeed cause urinary retention. Perhaps I didn't state that correctly the first time.
jimjames Greg123
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Jim
kenneth1955 mark23925
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Mark......do you have some urine output now. I hope you have not had the surgery yet. You will get retro and it sucks. Try something else. Like Jim said. Urolift...Pae...Rezum. And there are a couple of others that will help you. Even if you have to do CIC you may get control of you bladder. To me it does not seam that your prostate is the problem it's you bladder. Your doctor may not know anything else. Get a second opinion before it to late PLEASE Ken
mark23925 kenneth1955
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kenneth1955 mark23925
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Mark I think your doctor does not know anything other what you wants you to do. That will give you retro. Most doctors do not think that is a problem at our age. Rezum is a minimally invasive procedure that using water vapor to make the prostate smaller no cutting. Also there is iTind Procedure. It is a divice that is put in for 5 days and they removed. It make new channel for you to pee from. I would talk with another doctor before you pick anything. And about the urolift It would open up the prostate to help you pee better. I'm sorry but I think your doctor is behing the times. He is telling you that you are forced to do the green light. I think he is pushing for it. Get all the information before anything you do. Ken
kenneth1955 mark23925
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Mark I gorgot to ask do you have a stricture. That may be way they have a problem. I have a stricture just before the prostate. I can only have a 14fr coude catheter. Some nurses don't know how to use them only regular catheters. Urologist only do them the best. Most of the time my doctor has put it in. Maybe when you fell you mess something up in that area Please think before you do anything. Do something less invasive first you can alway go back Ken
mark23925 kenneth1955
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mark23925 kenneth1955
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stebrunner mark23925
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Hi, Mark,
A year ago I had acute urinary retention--and at the hospital they drained 7000 mls out! Yep, 7000 mls in one shot. I almost lost my kidneys, and I was told I'd never regain bladder function. My urologist said that I only had a chance to pee if I went with a suprapubic prostatectomy. And my urologist really put the pressure on me to decide, even using a sales technique called the silent close. I opted to keep the Foley catheter in so I could research my treatment options. Foley's have to be changed out every 4 weeks, and I had 5 in over 3 months.
From personal experience I can tell you that a lot of urology nurses and hospital nurses don't know how to put a Foley catheter in--and they can make it incredibly painful. I didn't think I could ever self cath because of that pain. The first urology nurse I had tried to teach me how to CIC (self cath) but did a poor job. Then I found this forum and a thread on self catheterization that helped me succeed--and I changed uro's, and the new uro's staff is much better at working with catheters. They can put Foley's in without causing pain!
I've seen 6 uros over the past year, and each had a surgery he specialized in. Each said his surgery would allow me to pee normally again. But when pressed on my exact odds of that happening, each backpeddled. My problem is twofold--a large prostate restricting my urethra and weak bladder muscles. Clearing the "pipe" won't do any good if the "pump" is bad, if you know what I mean. The uros were clueless on how to rehab my bladder muscles.
Learning to CIC is the best decision I've ever made. It took some time to master it, but it gave me time to make a good decision about my treatment plan. BTW, my prostate size was 90 gm with a large median lobe, and that limited my treatment options. I went with PAE this past June, which helped me a lot. I still CIC but can pee 100 to 200 mls on my own. Now I'm in the process of rehabbing my bladder tone. CIC allows me to live my life as I did before--and I still have all my sexual function.
When my rentetion event happened, it felt like I had been in a bad accident. I suddenly had to start researching medical terms and treatment options, and I felt like a fish out of water. Coming to this web site and reseraching is a good place to start. You'll find a lot of support here, too. Best of luck to you as you make your decisions!
Stebrunner
Stebrunner
mark23925 stebrunner
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mark23925 stebrunner
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Alot of doctors will have different opinions and you can not question them when they give their opinion, they blow you off. It is a question of , "Who is the doctor me or you, do what I say." Doctors do kill people and do make the wrong decisions all the time. I need to think clearly.Difficult
kenneth1955 mark23925
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Please research more before it done. Cancel it . You have the right ywant not want the doctor want you to have. you half to be happy.You have to wear a catheter but who know after he cuts out your prostate that you still have to wear a catheter. I still don't think its you prostate it' your bladder He will tell you who know what happen when something goes wrong. Go to another doctor for another opinion please you will not be happen when you have something happen You said you don't want retro so fight for it. Don't let being uncomfortable about the catheter rush you into anything please. I don't want you to be unhappy Ken
kenneth1955 mark23925
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hank1953 mark23925
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Normally when Jim (jimjames) is already involved, I stay on the sideline since Jim is the resident expert on this retention subject. However, what happened to you already happened to me, eerily, perhaps with not the same intensity. I came back from it and I can answer any questions you have. In the mean time by all means:
1. Keep the Foley catheter. Your kidney is impaired, probably flooded with urine, you need the Foley to help drain it. CIC can come later after you are stable. Do not go for any surgeries out of panic. It may make matter worse.
2. Cut down on your liquid intake, 4000ml is too much for an impaired kidney to handle. It is one reason why your blood pressure stays high. 2000ml is the top limit for now. Also, the preferred liquid is water.
3. Adapt a kidney friendly diet: cut down (not eliminate) on protein, sodium, potassium, phosphorous. That means no processed food, no soda.
4. Stop taking pain relievers like ibuprofen , aleve.
5. Take control of your blood pressure. Some BP drugs may not work under this situation. I know metoprolol did not work for me, it even raised my BP and caused a steep decline in kidney function. It can be tough because it is a vicious cycle. High BP causes kidney problem and impaired kidney raises BP. I ended up taking Bystolic. It has less side effects than other low cost drugs.
6. Try to stay calm or if you can not, ask for some medication (Xanax) to calm yourself down. Being anxious of your condition will raise your BP. Be sure that once you follow 1,2,3,4, and 5, your situation will be better and stable in few days.
Hope this helps.
Hank
jimjames hank1953
Posted
Hi Hank and Mark,
Mark, I think we agree in principle. I suggested the suprapubic with Flip-flo because it does everything a Foley does but is more comfortable, preserves a semblance of normal lifestyle, and has less incidence of infection. Studies suggest it superior in all respects to a Foley in timelines like this. As to blood pressure, I don't disagree with your suggestions but a lot of it can be kidney back pressure (hydronephrosis) which should resolve completely within a week or two of complete bladder emptying, be it Foley or Suprapubic.
Jim
Jim
Jim
mark23925 hank1953
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mark23925 jimjames
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jimjames mark23925
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Mark,
Mark,
Not exactly. What I said is that: (1) Greenlight is a major surgery that can result in retrograde ejaculation; (2) If you're not OK with this, you should shop around for less invasive surgical options; (3) In the meantime, you need to protect your kidneys and catherzation, either self cathing (CIC)_, Foley or a Suprapubic will protect your kidneys as well as any operation; (4) Since you can't do CIC, that just leaves Foley and Suprapubic of which Suprapubic is superior in that there is no tube in your urethra and therefore more comfortable and will give you more independence.
Jim
mark23925 jimjames
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hank1953 mark23925
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Hi Mark,
If clonodine helps lower your BP, you should take it for a while to stabilize your kidney. Your high BP at night is probably caused by your kidney and your anxiety. Clonodine should help. Not taking measurement at night is better for anxiety.
4 x 16oz only comes out to be about 2000ml. Unless you eat a lot of wet foods, where does the other 2000ml come from ? The 2000ml limit includes all liquid intake, yes, all together.
No, I did not tell you to starve yourself. Just eat a little less, but with mostly kidney friendly foods for awhile.
About workouts, do not do heavy or strenuous exercise, yet. It is bad for the kidney now. Instead, take slow relaxed walks. It's good for BP.
Hank
jimjames mark23925
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Mark,
Do you have an internist or cardiologist managing your bp? If so, I would not self medicate because certain combinations may do harm. I'm not a doctor but your doctor doesn't seem to think those temporary spikes are putting you at cardiac/stroke risk and I tend to agree with him. As to more fluid out than fluid in, your kidneys may be just temporarily unloading so be careful about cutting down fluids or you could go into dehydration.
Jim
Jim
hank1953 mark23925
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Hi Mark,
Don't overly worry about 180/100. It is not that high, as long as it is for only short term. Mine was much higher and it came down.
Focus on some thing else. Keep busy.
Hank
mark23925 jimjames
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mark23925 hank1953
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kenneth1955 mark23925
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Mark I think you are taking to much blood pressure meds. That is why your spikeing. I am on Lisinopril 10mg for the last 5 years also 2 blood thinners. Heart is doing good now had a heart ablation done. My blood pressure would go up sometime but it is cause by stress. You have to relax or your going to give yourself a stoke being worried about all of this. I think your prostate is fine it's you bladder. Stop drinking so much What Jim is saying about the the Greenlight is right it is a major surgery and you don't know if it will help so why have it. If you don't what to have a catheter in your penis get the Suprapubic catheter. It is much better and will give you more freedom and it will not cause retro. Try it you can allways have it taking out. Look into something else. Don't go for major surgery because once you have it done it will be to late and also there have been men on this site that have had it and 3 month's later they have to have a turp to clean up the mess.. Please look for other option...Ken
mark23925 kenneth1955
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You might be correct about the blood pressure medication. I had high blood pressure about 5 years old. I collapsed at work with pressure of 220/110. Vomiting and spinning. It happened 3 times over a two week period. They never could figure out what caused it. So at its worst ,they finally stablized me on Lisinopril 20mg twice daily, Coreg 20mgCR once day and clonidine 0.1mg for spikes. But than slowly the blood pressure problem appeared to just go away. I do eat completely differently now, mostly vegetables no sweets, some chicken and fish; but I was not even taking Lisinopril 20mg and my pressure was always normal, what changed everything was when my kidneys stopped working due to the urinary retention and than the blood pressure started up. I was on the treadmill one hour a day, no problem at 3.8, and I was lifting weights, tough regiment, no problem. It could be the medication is goofing me up. Right now it is low 100/80. In regard to the Greenlight, I don't want to retain 3000ml of urine. My priorities are being able to exercise, of course retrograde ejaculation is not something anyone looks forward to. With regard to the Suprapubic catheter what do they do to fit it, how is it done?
?An older Urologist he is about 80 , told me to have a TUMT and saw he thought Greenlight was barbaric. Thanks.
kenneth1955 mark23925
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Don't listen to him either. Just look it up. The procedure causes retention for a month after. You are trying to fix the problem not cause more. It also will give you retro. Also it said that to fix the retention they will put in a suprepubic catheter. Look it up They put it through the lower abdominal wall into the bladder. After the tube goes down your leg into a leg bag. You can still do alot and your sex life would be saved. They will put you out so you will not feel a thing. It has to be changed 1 time a month Maybe with it it will give your bladder time to heal. Take care and good luck please look at other option. Did you cancel the GL you don't know if it going to help or not. I still don't think the problem is your prostate it's your bladder......Ken
mark23925 kenneth1955
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kenneth1955 mark23925
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I think that the bladder is scratched out with all the water that the doctor told you to drink. and the pills yours taking are causing more of a water out take from your kidneys. I'm not a doctor but when I had a catheter I was told to make sure I drink water not 5 or 6 bottles or more a day Get a second opinion please could be the bladder neck you said you never had a problem before your fall. I'm going to look more up on this. Ken
hank1953 mark23925
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OK Mark,
Normally BP spikes up after consuming too much food or drink, especially of unfriendly stuff. Your BP spikes up at 4 AM so I assume it is not due to recent food or drink.
Another likely reason is the BP meds wearing off. I am not familiar with your specific meds but in general, their effectiveness reduce significantly at the end of their time. You can look at the half-life of a med on the net. Let's say, a med has a half-life of 10 hours. After 10 hours, the strength of the med is only 50% of its peak, and going down further as time goes by.
I found this out and I asked for extended release BP med. Again, 24-hour XR med can still give you spikes if you take it once a day. The trick is to take 1/2 of the dosage at a time, 2 times a day about 12 hours apart. For myself, I take Bystolic. This med has extended release in term of days, not hours.
Another thing when I had my attack was to practice deep breathing. It seems to help, bringing my BP and HR down, at least to keep my mind off worries. You can ask Jim for lessons on this since I am a flunk out Yogist.
Jim was right in advising you not to self medicate. However, if you already took Clonodine before and it is the only thing in your possession that can lower your BP than by all means take it. And ask for more next time you see your GP. I had it before and it was very effective to lower your BP and also calm you down. I am not sure it is a long term solution though. But you need to lower your BP now.
Visit between doctors are too far in between during time of crisis. Also doctors may not know many of the complicated problems that we have. My doctor seemed clueless and not believing on what was happening to me at the time. She even told me not to take my BP more than once a day. She told to take BP med, wait for one hour and take BP when your are calm and relaxed. She never gave me any diet advises. If I did not take control of my treatment, I would be on dialysys or worse right now.
Hope this helps.
Hank
jimjames hank1953
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Hank and Mark,
My concern with "self medicating" here was not that Mark couldn't tolerate Clonodine, a drug he has taken before, but that by adding it to what he is already taking could be dangerous. As others have stated, bp spikes like this are not that unusual. I have had them myself from time to time. Hopefully, as kidney pressure is decreased through the Foley process, blood pressure will start to stabilize.
This isn’t to say that the drugs might not need tweaking, so by all means call your doc and go over your blood pressure log with him and bring up Clonodine once again. He told you last time not to take it but sometimes they change their mind or he might have a reason why he wants you on the current drugs. Ask him.
Jim
jimjames mark23925
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Mark,
Too often Urologists blame everything on the prostate but voiding is complicated process. Even if your prostate grows and starts to obstruct your urethra, you could probably void OK as long as your bladder muscles are in good shape. But what happens over time is that the bladder gets stretched out, its muscles weaken. Because of this the bladder can no longer empty properly causing retention which then causes more stretching. It's a vicious cycle.
So, in the case of a badly stretched bladder, even if the doctor removes the obstruction through an operation like TURP, GreenLight or Holep, the stretched bladder may still not function properly and you may still need to catherize even after the operation.
The good news is that bladders can sometimes be rehabilitated to one degree or another by decompressing them through catherization and letting them heal.
In my opinion, too many urologists put the cart before the horse. They first remove the obstruction (prostate tissue) and then worry about the bladder later. But by dealing with the bladder first, not only will you potentially get better results with a surgery but if you're lucky you may not even need one, or at least not need one of the very invasive surgeries.
Right now, you're on a Foley, so your bladder and kidneys are protected. If you're determined to do a GL, at least do urodynamic testing first and get a good idea if after the GL you will be able to urinate without a catheter. Alternatively, you can look into some of the less invasive procedures mentioned.
Meanwhile, you need to keep draining the bladder so that means either staying on a Foley or changing to a suprapubic. If you're unfamiliar with a suprapubic, look it up. It will be a lot more comfortable than the Foley and let you go on about life pretty normally until you make a decision.
Jim
hank1953 jimjames
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I am guilty as charged for self medicating, and my doctor knows it. As soon as I know that my BP rises significantly, I either start or up my BP med until it stabilizes just for the kidney sake. On the other hand, as soon as BP stabilizes or declines to near the low safe level, I cut down and/or slowly wean off the med completely.
I always save some of my BP meds for this reason. The one time I was admitted to Emergency due high BP (210/110), all they did was giving me Clonodine + Xanax and told me to see my GP. So I figure having extra BP med on hand has saved me from going to ER again.
Hank
jimjames hank1953
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Hi Hank,
I am also "guilty" of self medicating That said, it sounds like both you and I have a track record here and have done some trial and error as well as some research. Not so sure that holds true in Mark's case plus his circumstances are unique with what is going on with his kidneys right now. It may be that his doc is under treating his bp but then again there may be a reason for the current regimen. I think he owes it to himself to find out from the doc before going rogue.
Jim
mark23925 hank1953
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mark23925 jimjames
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jimjames mark23925
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Yes, you do have to stay on a catheter now, but you don't have to have a tube up your urethra 24/7 like with a Foley. So ask your doc about putting in a suprapubic catheter instead. That will buy you time to look at other options.
Jim
hank1953 mark23925
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Hi Mark,
I agree with you. You did the right thing by taking clonidine. I you wait to see doc, it maybe too late. Go to Kidney and CKD thread, many of those people that either did not know they had high BP or waited to see docs are on dialysys or transplant list right now. I a way, both you and I are lucky that we know that we had high BP and did some thing about it.
Another good thing about you is that you are already on a healthy diet, so the recovery will be quicker. However, I notice that you eat a lot veggetables that are high in water content. That maybe where the extra water come from. It has to come from somewhere. Otherwise it would be a miracle and you could solve the global drought problem.
Hank
mark23925 hank1953
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mark23925 jimjames
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jimjames mark23925
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Yes, it's a surgical procedure under sedation which I believe can be either done as an outpatient depending on the hospital. Instead of a tube coming out of your urethra, there will be a small tube coming out of your lower abdomen that will either drain into a bag or into a toilet depending on how you set it up. The incision in the bladder heals completely when it comes out and I doubt if it leaves much of a scar, if any, in the abdomen.
It was a procedure I was seriously considering myself when I ran into problems with self catherization early on. The advantage is no tubes in the urethra and no leg bags if you get at Flip Flo valve. Also less chance of UTI's than with a Foley. If you don't like it, they just pull it out and the bladder almost immediately closes the hole. No additional surgery required.
Jim