Kidney Failure 6 mo postop cryosurgery

[Sandragene]

My 56 yr old husband was diagnosed with prostate cancer, Gleason 8, in May 2007 and in Aug had cryosurgery, which was the recommended treatment by his urologist. Everything went well except a bacterial infection 2 weeks postop. His PSA's since then have been "normal, exactly as expected" per the doctor. Then 6 mos postop he suddenly had 1 wk of non stop urinating day and night. The urge was intense and constant even though amt of liquid, diet, work etc had not changed. Then while waiting 2 days for doctor appt, he started belching loudly, vomiting black vomit violently and had bad nausea. No fever. Doctor did urinalysis culture and prescribed Levaquin, 500MG as antibiotic and Utira-c. Over that weekend he went downhill fast, to the point that he asked if he was dying! All of a sudden he couldn't go to the bathroom at all and then late Sunday he lost all control of his urine, the side effect of the Utira-C evidently is the urine turns a turquiose color, and we now had this staining clothing, toilet and sheets!! Monday morning we got emergency appt with the urologist and he did cystoscopy and drained off I believe 600 ccs of this green/blue urine and then checked for obstructions etc but didn't find anything. He inserted a catheter and then we went back the next week for self-cath lessons. During that time we had a CT of his abdomen done and an abdominal ultrasound done. Removing the cath does no good. He doesn't feel any urge to go and can't feel any fullness. He is having a urodynamic evaluation done later this week. When we asked what caused this, the doctor said he doesn't know. I asked if this is prostate cancer that is spreading or complication of cryosurgery and he said no evidence of spreading and way too long after cyro to be complication. For the vomiting, nausea and belching he referred us back to our primary care who did upper gi and found hiatal hernia, no ulcers. So he was in kidney failure per the doctor but now does not know the reason for not be able to pee without the cath. Our primary care doctor that we know very well after 15 yrs, said that between us and him, he believes this whole urinary stuff is the prostate cancer progressing. His appetite is half what it was last year, he has lost 30 lbs very fast. He does feel okay as long as he is self cathing but is weak and visable changed not only with weight loss but his skin is very very dry and flaky. He is not dehydrated and has good output with cathing. How do you think we should proceed with this? Just believe what the urologist/surgeon tells us (he is very highly recommended by all doctors that we know) and we have alot of confidence in him. But we also value the opinion of our primary care doctor. We would like to know the cause of this and if he is going to be self cathing for the rest of his life, however long that will be. I am of the opinion that he should have another bone scan to see if any evidence of cancer. The one he had prior to the cryosurgery didn't show any outside of the prostate but it says 37% chance that it was outside prostate, too microscopic to show at that time. Can you give me some advice or your opinion? This waiting to see and waiting for more and more testing that doesn't show us anything definite is very hard. We would rather know the cause and what to expect. So any advise and opinions are welcome!! Thanks, Sandi

[HeinrikMD]

Hi,
Its very hard to say what exactly is the cause of the kidney failure. The infection if severe can cause renal failure. If there is dramatic fluid loss (persistent urine) followed by decrease in urine and obstruction of flow may actually have started paradoxically from the obstruction. There is a phenomenon of overflow or excess urine after a period of obstruction. How long the period of obstruction before this happens is hard to say. Some kidneys may fail in less than a day if there is obstruction.
What is more critical at this point it seems is the reversibility of the kidney failure. If there is now constant urine (although there is a need for catheters), it seems the kidneys have recovered.
The cause of obstruction would be best discussed with your doctor. One of the more common reasons for it would be strictures causing narrowing of the passageways of urine. The strictures occur as part of healing. Patients may regain adequate patency over time - but there is that period of catheterization.
Whether all of this heralds disseminated cancer is unlikely. IF the PSA dropped to the expected levels after surgery then dissemination is very unlikely. Weight loss is pretty non-specific - some men do tend to lose weight after surgery consciously or otherwise.
Discuss your concerns with your urologist at length, as he can give you a better estimate of how long you'll expect to keep with the cath.
Stay positive.

[Sandragene]

Thank you for your answer and kindness. The doctor did not find any obstructions during the cystoscopy. The abdominal CT didn't show either. He had the urodynamic evaluation today but I doubt if it will show much because from what I understand this test records the speed of the urine, how well the nerves tell when the bladder is full, how well the sphincters hold and release urine, measures leaks when coughing or laughing, the pressure when urinating, and how the urethra holds urine, but he cannot urinate at all without the catherter, he doesn't feel any fullness or urgency at all. He also doesn't leak now at all. He only knows to cath himself at least every 2-4 hrs because that is what he is supposed to do. He drinks lots of water and juice, some iced tea and maybe 12 oz of pop each day. We live in the Arizona desert so we also make sure we are hydrated.