Watchful Waiting.

Posted , 7 users are following.

I have been following the discussions on this site with interest as I am 61 years old and have BPH with an elevated PSA of 5.1 and my urine flow is restricted but manageable. My BPH was diagnosed around five years ago when my PSA was 4.7 and so far I have avoided any medication and have opted for watchful waiting by monitoring my PSA every four months. Should the PSA level shows a significant increase I will then have a high resolution MRI scan and needle biopsy in case of cancer. 

As the slow urination problem is likely to increase I am interested in what I might do to manage this problem and am reassured that self catheterisation may be possible as an emergency intervention. (I am a sailor and a complete blockage is a bit of a concern when I’m days away from help) I am going to obtain a free sample of a compact single use coated catheter in order to try it for myself. 

For the technically minded, I found an excellent article on Transurethral Resection of the prostate by Matthew A Collins, MD, Resident Physician, Department of Urology, Medical College of Georgia, Georgia Regents University. Although primarily intended for surgeons, this article has given me a much better understanding of my prostate.

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  • Posted

    Since you're only going to keep the catheter for emergencies, I would stay away from the "compact" catheters, and get a regular one, as they are easier to use.

    Also, if you have an enlarged prostate, get one with a "coude tip" so it doesn't snag your prostate when inserted. 14 French (14F) is the usual starting size. Of course, ideally go over everyting with a doctor. 

    I would also practice some at home, so if an emergency arises, you won't be doing it for the first time.

    FYI "single use catheter" is a often a mis-used term. Almost all catheters sold -- with the exception of hydrophillic catheters -- can be used multiple times, in fact up to two weeks. This is common practice. Hydrophillic catheters, because of their unique slippery coating, are truly single use and must be discarded after being used. 

    Hopefully, you have a urologist who can show you how to use the catheter. If not, there are a number of videos online. 

    I've been self cathing on a regular basis for a couple of years now and it has allowed me to avoid getting an operation. I don't know what your exact situation is, but a restricted flow often goes with a retention and high pressure condition. Both of these can lead to serious kidney damage if not treated either by an operation, or something like self-catherization. 

    I assume you've had bladder/kidney ultrasounds on at least a yearly basis? If not, you want to have them to rule out any kidney issues caused by urinary retention such as hydronephrosis (water in the kidney). 

    Jim

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  • Posted

    I am reminded of the start of my watchful waiting in 1995. When I spoke to the Urologist about holidays he said to be always near a hospital in case of retention. Don't go to any islands he said. When I told him that we were thinking of going to Zambia he held his head in his hands.  

    As my prostate grew from 35grams to 75 my PSA went from 5.0 up to around 9.8. Big prostate = high PSA. After having a PVP in 2005 my PSA went back down to 5.1.

    How big is your prostate? 

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  • Posted

    Hi CaptainAl.

    When you say you are a sailor, is that on deep sea, coastal, or leasure ?

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    • Posted

      I'm a leisure sailor but often a couple of days sailing from civilisation at times. So far I have always managed to pass urine but it can be an intermittent and lengthy process. The idea of obtaining a catheter was for emergency back up & may prevent an emergency situation at sea.
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    • Posted

      I echo some of "lander's" concerns in his recent post. It is very important that you and your doctor are on top of the situation. Have you had periodic bladder/kidney scans? Do you know what your post void residual is? Are the kidneys clear or did they show any signs of hydronephrosis (water in the kidneys). Left untreated, urinary retention can get you into a lot of trouble. It did with me, as I "watched and waited" a little too long! And as to self-catherization, of which I'm an advocate in many cases, you really do need some instruction or at a minimum do some research before just trying it out, and of course, let your doctor know what you're doing.  I assume you're under the care of a urologist, and not just a GP? If not, I would see a urologist.

      Jim

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  • Posted

    "As the slow urination problem is likely to increase......." and  "So far I have always managed to pass urine but it can be an intermittent and lengthy process"

    sorry to be terse Al but have you told your doc about the full extent of your problem?

    also just sticking a self cath up & into your bladder for the 1st time   without any professional instruction or advice  is imho a seriously bad idea.

    you should be consulting a urologist - the problem will not get any better & you can almost be guaranteed it will get worse.

    cheers

     

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  • Posted

    Some really helpful advice here. 

    I've really not received much help from my doctor or urology department (as yet). No scans so don't know the extent of the prostate enlargement or bladder retention, nor have they carried out flow tests, etc. However my latest PSA which has increased to 6.8 from 5.1 in April - which is a bit of a concern. Will have it checked again in a few months and if the increase persists will arrange for a scan and biopsy. I'm also going to enquire about additional tests as suggested on your replies and discuss self catheterisation before trying it out on myself. 

    Thanks again for all your support, Al

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    • Posted

      Hi, Captain,

      The scans have nothing to do with your PSA going up or not. My PSA has always been under 1, but my kidney and bladder scan showed not only significant retention, but also Hydronephrosis which is a swelling of the kidney due to urine retention. Untreated, this can caus permanent kidney damage. So don't wait, make an appointment with a urologist now to prevent things from getting worse in the future.

      Jim

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