BPH/Bladder/Ureter problems

[Rob616]

I am 58 yrs old, have BPH and had not taken medicine for the condition, as symptoms were not that bad. While in S. America in November, I had pain which was thought to be from kidney stones. I was given scopolamine. The doctor didn't ask about BPH and I didn't know that the med had side effects related to prostate. It became hard to urinate any more than small quantities at a time. I began retaining fluids, something that was determined after I returned home to US. I was catheterized and have had the catheter ever since, except while being tested in various ways. CT scan did not reveal stones. Cystoscopy revealed thick walls to bladder and, as the doctor put it, a bladder that appears much older than my 58 years, i.e., diverticula. He also saw an unusually large opening to left ureter. (By the way, an earlier ultra-sound revealed that this same ureter is much larger than normal.) He mentioned a possible surgery for reimplantation of the ureter. After the cystoscopy, my urologist ordered a Uro Dynamics test. He was surprised by results, which showed a strong bladder function and even too much pressure inside the bladder. Based upon what he saw with cystoscopy, he expected to confirm a decompensated bladder. He and the 11 urologists in the group have never seen such a scenario. He wants to be cautious before preceding...which I appreciate. We are looking for a urologist who may have seen similar conditions. Any suggestions or help will be welcome.

[Stephen Liroff, MD]

Yes, you are correct, I have gotten behind in my answers. I am catching up, however.
I do not find your thick walled bladder with a diverticulum and a dilated ureteral orifice totally unique. Your bladder has been compensating adequately for the obstruction created by your prostate until the drug made it impossible to empty. Now that your bladder has recompensated, you might actually be able to empty using an alpha blocker such as Uroxatral or Flomax, but I would not recommend doing that in the long term as you are skating on the edge of decompensating again. I would recommend that you have a prostatectomy and then be followed for adequacy of emptying and urinary tract infections. If you are not emptying or have recurrent infections, then I think that you should have a fluoroscopic voiding cystourethrogram to see if you have urinary reflux into the dilated ureter or are not adequately emptying the diverticulum. At that point your urologist can make a decision regarding  a ureteral reimplant (or possibly having a Deflux implant, such as we often do in children) and/or a bladder diverticulectomy (removal of your bladder diverticulum).
The immediate problem is getting rid of the prostatic obstruction, the rest can be treated later, and they ultimately may not need  any treatment.
S.A.Liroff, M.D.

[tieukn1]

A related discussion, Blood in Urine: Post PVP surgery was started.

[Stephen Liroff, MD]

I am glad that you are doing well. The statistics are in your favor!
Thanks for the follow-up.
S.A.Liroff, M.D.

[Rob616]

Thank you, Dr. Liroff, for your reply! In the meantime, and after consulting with colleagues at Vanderbilt & Emory, my urologist did decide to go ahead and deal with the obstruction. (His caution had been a fear of it resulting in permanent incontinence.) On 12/30, I had the PVP surgery. He said the prostate was larger than it had shown to be on the CT scan AND that my bladder looked better than before. Today I had my post-op visit for a voiding trial. Good results, and I came home without a catheter...after 2 months with one! So far so good, as I have urinated almost normally the last several hours! He gave me Uroxatral to take over the next 3 weeks, at which time I'll see him again. To the extent that he and I may have to talk about any future surgery, I'll find your suggestions concerning cystourethrogram, urinary reflux, ureteral reimplant, Deflux implant, and bladder diverticulectomy very helpful! I'll research those in the coming days to be ready for those conversations. But as you suggested, perhaps further surgery will not be necessary...hopefully!! Thanks again! Rob616

[Rob616]

This was my post. It was concerning a serious condition, as opposed to some of the things I 've seen here since becoming familiar with the forum. I just wanted to express my disappointment with the lack of any reply whatsoever from the doctor. It has been over a month, and I obviously no longer expect one. Rob616