I would very much appreciate your consideration of the following:
I am 59. I have BPH, and have managed it for the past few decades without any medication. Unexpectedly, 2 months ago I had my first Acute Urinary Retention episode, which I think was triggered by some “ejaculatory stress”. A series of catheterization and 2 more AUR’s followed, one after the other. Twice now I have removed the catheter (at doctor’s direction) to see if I could urinate without it. Both times I failed, and had to be recath’d The third test is coming up soon.
I’ve been on Flomax/Tamsulosin and Finasteride for nearly 2 months now, My current catheter is 18 Fr Foley. I empty about 1500cc per day. But starting a few weeks ago I can also urinate, under control, OUTSIDE the catheter 25 to 50cc each time I feel the need to urinate. It’s not strong urge, but I do feel it. At those times all I do is sit down on the toilet and relax the (sphincter urethrae?) muscles, while not pushing at all, and 25 to 50 cc’s comes out into the toilet.
The Urologist thinks I’ll need surgery if this next removal doesn’t work. But this doesn’t make sense to me, as it seems the Flomax has increased the urethra passageway such that I “leak” outside the catheter.
The last time the catheter was removed, I started urinating while sitting. I was very glad to be able to do that. It started at 25, then 50, then up to 100cc. So the next time I felt the urge, I decided to stand to urinate rather than sit, and that’s when the problems started. There was a pinching feeling (both at sphincter urethrae and “levator ani” pubic floor muscle? “levator prostatae”?), and I could only get 50cc out. I sat down, and then got another 50. Thereafter it gradually got worse, until I couldn’t urinate at all, and then had to be recath’d. This was over the space of about 6 hours.
Why did this happen? Was there a muscle interaction, or did the prostate just resume it’s constricted geometry since the catheter was no longer forcing it open?
I’m wondering if there could be a spasm, or wrong electrical signals being sent that causes the passageways to constrict and muscles tighten up, even when there really is enough space through the prostate if everything was relaxed. Could there be a problem associated with the sphincter muscles and the pubic floor muscles?
I have not been able to find any information on this subject on the Internet and would greatly appreciate other experiences and knowledge sharing.
When you say "Outside" the catheter are you talking about voiding with the cateter removed or are you voiding around the catheter with the catheter inserted. With BPH, your prostate is enlarged and restricting the flow of urine. Do you have any type of spinal cord injury or maybe a neurogenic bladder? If you have bladder spasms, this would cause you to flow around the catheter and if strong enough, it could cause the catheter trough the urethra even with the bubble inflated. A trans-uretheral recection of the prostate (TURP) surgery may help you a lot.
Thank you for the response and questions and advice, Millard. The catheter is in place, and the leaking/flooding/voiding is around the catheter. The urine that is coming out in this manner is usually around 20cc each time I feel like voiding, and the color is cloudy and has white floaty stuff in it.
I don't have a spinal cord injury. I don't now about bladder spasms. Usually I just relax the muscles and the urine comes out. In the past day or so it's been a little uncomfortable as if the muscles were pushing it out or something. Don't know how to describe it.
Update. Had a cystoscopy/cystography done yesterday, with a machine that did not record the results, but ony view. I viewed the display too. The Dr said my prostate is enormous, and there's no way I'd be able to urinate without surgery. I tried to urinate on my own for a few hours after that procedure, after my catheter was removed, and while I could at first, later I couldn't. It seemed that the build up of pressure of urine in my bladder was making it too difficult (I dumped about 1.5 liters in me right after the cystoscopy, and they had also put 300ml into me during that procedure.) So very disappointed. He also saw a growth of some kind near the bladder opening and said it needed to be biopsied. He wasn't sure whether it was due to catheter abrasion or something else. He said my bladder walls were thick, and too smooth, I think, and not the regular texture. He said I might have bladder cancer. But the first thing to do is GreenLight, because that's what he does, and at the same time take the biopsy.
With regard to the "flooding" around the catheter, his response was like the other urologist; The bladder is pushing the urine out. Some of it gets around the catheter." It had seemed to me, previously, that I only needed to relax the sphincter muscles, and I'd always get out 20 to 50 cc's of urine outside the catheter. That's what gave me hope that Flomax had solved my problem. But the urologist said Flomax wasn't helping and said I can just stop taking it.
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