Urinary Retention

In my case can not do self catherization, because only urology surgeon could get in with catheter, 2 nurses tried , no one could get in. Several years ago tried urodynamics and could not get catheter in. My doctors says Uro lift will not work in my case. He is vacationing and Ihave a catheter in me now which spits out about 4000 or more ml of urine daily.

​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?

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

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.

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.

-------------

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

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. 

Greg, Yes, you are correct, Procardia is associated with urinary retention. I was thrown off a little when you mentioned frequency, so I thought diuretics. I am assuming the frequency on Procardia is a result of the retention and not the other way around, but it just could be the drug itself. Always important to check our medications as a first step in figuring out what is wrong!

Jim

Dr says in my case Urolift will not work. Took a urology surgeon to get catheter in with scope, 2 nurses could not do it. It is something about the way my prostate is positioned. 3000ml of urine came out initially and 7000ml more in 48 hours. Lost 10 pounds of water and weight. Who knows how stretched out my bladder is and whether I will need diapers after surgery. My kidneys were shutting down and no one knows why.I do alot of weight lifting take no supplements and do very vigorous workouts. I fell and my knee swelled so bad, I was bedridden for 10 days and sleeping alot and than the constipation , very bad, had to take loads of Milk of Magnesia and than got diarrhea. Doctor did not know what was happening and no one took a blood test to figure out my electrolytes and markers were going in to dangerous terrible. My urologist says Uro lift will not work in my case, I think it is too late for PAE, do not know what to do, I have a catheter in me that is giving out 4000 or more urine a day and I now get blood pressure spikes in the middle of the night 180/100. I would not be able to do self catherization because only a surgeon could get in. He says I am forced to do Greenlight, Yes I do not like it, but what can I do? What is Rezum

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

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 

True, you can always go back, but I was close to dead. 14fr did not work, it is something with the position of the prostate to bladder. I mean that is what the physician said.

He might have economic interests. He is quite popular, but that does not mean he is on target.  I could ask about Rezum or about I Tind, we could reschedule. but I must keep catheter in, my kidneys will stop if I take it out. Danger

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

 

Yes the doc said only a urologist would know how to get in with a scope. But your plan is interesting. But now I get spikes in blood pressure 180/100 suddenly it wakes me up in the middle of the night. The 2 blood pressure medications they gave me do not stop the spikes. But before all this, I did not need blood pressure med. I am loosing my mind.

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

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 

Mark NO DOCTOR SHOULD BRUSH YOU OFF THEY SHOULD ANSWER ALL YOUR QUESTION  Ken

Hi Mark,

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

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

I record the amount of liquid urine coming out every 24 hours, and it appears more than 4000 ml is coming out and I can not ever remember this amount of urine coming out of me. Just woke up, it is about 11pm and at 7pm felt exhausted and went to sleep. The doctor did tell me in the beginning when the cathether was placed to drink 4 bottles of 16oz water daily and I am doing that. My diet was and has been very clean for a few years now, I eat onions,broccoli,celery,garlic,all types of colored peppers and a little chicken, no saturated stuff. But what really has me nervous is that at about 4am, for no apparent reason why blood pressure rises to 180/100 in the middle of the night and it will not go down, I am already taking lisinopril 20mg and Coreg ER 20mg, so I am afraid I will get a stroke or there is a blockage, sometime I have gotten a blood nose first, and so my doctor says stay calm, well easy for him to say. About 6 years ago this used to happen, spikes like this and I took clonidine 01mg to drop it. The doctor tells me not to do it, but I had some left in the house from the last time and it drops it to 140/90 within 30 minutes. So if I hear you right, you are saying the Coreg may cause the blood pressure to rise and I should cut down on fluids because my kidney is still not normalized. Having catheter in is not the best of all worlds but a neccesity, and yeah my normal workout routine was lifting weights 2 hours a day and knocking myself out and now I can not do this. But I am a bit exhausted from just regular activities. I just emptied the bag after 3 hours of sleep  it had 900 ml of urine in it. But now night is coming and sometime around 4am , it will happen the spike and that is what scares me, the night.  So I have put the prostate problem out of my mind now and my most pressing concern if I have a heart blockage or could I have a stroke. I am not overweight. I lost 10 pounds of water since my catheter was in, you should of seen all the water come out , it was amazing to watch.  You are saying to eat as little as possible and that more fluid and food will put pressure on kidneys that have gone through a tough time. Do I read you correctly? You are saying the blood pressure medication Coreg ER which is a combination alpha beta blocker may be causing my pressure to rise for some crazy reason. I have to ask the internist again what he thinks. thank you Mark

So what all of you are saying that the Greenlight procedure which is going to at least stop kidney shutdown and bring relief will cause more problems due to the aftermath, which I can not understand and which urologist is not telling me. Well he went to Florida and will be back in 10 days. So you think in meantime I should get another opinion. Someone told me my bladder is so stretched by now , I probably will have to wear a diaper for a month because I will not have the sensation and urine will be coming out all the time. Nothing to look forward to in the least; thanks  Mark

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

I understand.

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

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

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

MD tells me to take lisinopril 20mg in am and Coreg CR 20mg pm, but I still get spikes that wake me up at around 4am that scare me to death, 180/100 and I sit in the emergency room but I do not check in. I am not sure how high it will go and so this happened to me 6 years ago and I take clonidine 0.1mg to drop it. When I wake up in the morning I feel so thirsty I have to drink at least a whole bottle of water, completely dry, never had this before.

But it is so scary.  especially in middle of night. You blood pressure came down by itself without extra doses?

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  

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.

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

You could be correct, but what would be wrong with the bladder? What could have happened in bladder. Be specific. An older Urologist also seemed to think the same thing.

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

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

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

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

 

Hi Jim,

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

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

Alot of time doctors do not understand when you have a spike and it is going up , there is no time to wait, especially when it is super high, not 160/80 but higher. Yes clonidine 0.1 is a beta adrenergic blocker and it worked in 30 minutes. My spike was 180/100 and it went down to 139/80 in 30 minutes. If you go to the emergency room they put you on a table put you on a monitor on one arm and put an IV in another arm and they just watch our blood pressure and they do not do anything.  This happened to me 5 years ago and a doctor gave it to me prn and told me in emergency to take it. It works. Doctors rationalize anything, and to save your life, sometimes you have to do what works. I lost 10 pounds after the catheter because I was holding 10,000 ml of urine. Thanks for the concern. Mark

What you just said, my brother also said. My bladder is probably so stretched out by now, that even after Greenlight, I will have to work depends, and do Kegel exercises, and pray it works. But you see the catheter definitely has to stay in. Today in a 24 hour period over 4500ml of urine came out and I do not think I drank that much. I will think about what you said and maybe ask my urologist and get a second opinion with regard to bladder.   Mark

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

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

You are right.

Is it surgery when the insert suprapubic catheter? Do you see the incision?

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