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The role of Flomax when removing a catheter

My 77 year old father had a severe UTI in which his bladder was expanding like a small basketball (in part from not seeking treatment sooner)a few weeks ago. He was admitted and put on Levaquin intraveneously and sent home two days later. He was given a perscription for Levaquin but insurance would not cover it so they switched him to Avalox.  In the emergency room they said his prostate did not seem to be enlarged and the catheter went in easy. We saw the urologist four days later at his office.  He gave my dad a choice of having the catheter removed with the chance of returning or keeping it in until he did a cystiscope a few days later.  Not knowing his odds, my dad chose to have it removed; however, we ended back in the emergency room that night to have one put back in.

This UTI has really zapped the energy out of my dad. The next day my dad spiked a temp and the following day we saw the urologist again who said to be safe he wanted to admit him to the hospital.  He was put on strong antibiotics but has kept spiking a temp. After a week an infectious disease doctor is now working to find the cause of the infection.  (Although this is the most important thing to find the answer to, we will still have to deal with the urological problem.) At this point nothing is being done about the urological problem and I can understand why.  But we will be facing that once this is resolved.

My MAIN question is this:  Is it standard procedure (or at least pretty common) for someone to be put on Flomax (or equivalent) prior to removing a catheter to make urinating easier and is it always necessary to keep a catheter in up until the cystiscope is performed?  I have had other people tell me that their doctors would not let them leave the hospital without Flomax.

Also, does a cystiscope always have to be done on someone who was not able to urinate initially before again removing the catheter?  What steps would normally be taken?  

Also, what other possible explanations for the inability to urinate on your own and what test or tests would help determine the problem?  My dad said it was the pressure knowing he only had only so much time.

Thank you for your time.

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As I am not a urologist, I cannot speak from personal experience.  

Flomax is a medication that helps decrease the size of the prostate.  It is used in cases of benign prostatic hypertrophy.  I surmise that Flomax is needed to shrink the prostate to make passing the catheter in or out easier.  Shrinking the prostate would also make one less impediment to urination.

The catheter does not necessarily have to stay in up until the cystoscope is performed - this is up to the discretion of the urologist.  

There are various causes for urinary retention.  This can include an anatomical obstruction, neurogenic bladder (i.e. as a result from medications or infection).  The cystoscopy would be a reasonable next step to determine if there is any anatomical obstruction.  

I would also consider a neurology referral to make sure that there are no nerve conditions that can cause your symptoms.  

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
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