Urinary issues post-catheter removal

[sturn]

After RP, many men have problems with incontinence. My son, age 50, is having the opposite problem--he can't go. He had RP on April 2 with Dr. Vipul Patel in Orlando and was thrilled to get his catheter removed on Day 7. However, later that evening he was back in ER with an obstruction and left with a new catheter. After 5 days it was removed, and 4 days later he was back in ER for another one. It was removed last Monday, and now, 6 days later, he still just goes in dribs and drabs, it wakes him up all during the night so that he's not sleeping well at all. He's been very diligent about following instructions to a tee, drinking lots of water, taking walks and everything else the doctor's office instructed. He was told to start daily Cialis a few days ago and he feels that may have caused a problem, but he's just guessing. Any suggestions or idea? Anyone have a similar experience? Thanks for your input.

[Tall_Allen]

The anastomosis (where his urethra was stitched back together) is sealing shut,stopping the flow. Some men develop a lot of scar tissue. Sometimes it's just temporary from inflammation. A cystoscopy can detect the cause, but it's too soon after surgery - the stitches may break.

Cialis is known to improve the flow. I'm surprised they told him to drink a lot of water. Usually they want the patient to restrict fluid intake. Maybe have him call the doctor to check that.

[sturn in reply to Tall_Allen]

Thanks for this information. He has had two cystograms to insure the bladder wasn't leaking. The first time he went to ER, he learned he had a UTI and was then on antibiotics for 10 days, but the last time they said he had no signs of infection. He says he gets the definite urge to go but nothing, or very little happens. The first week he said drinking lots of water was the only way he could go. I think he feels the water will help keep things open, but I'm beginning to think, as you said, he should restrict fluid intake. He's so afraid of another blockage because it was excruciating pain. He definitely plans to call the dr again tomorrow. It's 4 full weeks now and he originally assumed he'd be back at work by now, but that will have to wait for at least another week, apparently. How long before one could have a cystoscopy? (Doesn't sound pleasant!) Thanks again.

[Tall_Allen in reply to sturn]

It's a strange feeling but not painful. Dr Patel is the best judge.

[TWTJr]

You have developed a post RP anastamotic stricture. Less likely, but also possible, is a retained blood clot in the bladder. Some patients develop excessive scar tissue post-op, particularly those who have had prior radiation. While 7 days with a foley is usually adequate, some patients require longer periods for healing to occur, allowing stabilization of edema and scar tissue. Unless you have had prior radiation, you need cystoscopy to rule out unsuspected problem, and have a foley reinserted, leave it in for 2 weeks, and also learn how to self-cath to deal with what may be a chronic problem of recurrent obstruction related to scar formation.

[sturn in reply to TWTJr]

Thanks for your reply. Are you a physician? My son is age 50, never had radiation. Amazingly, he just called and said things are going well today and he had a much better night's sleep, for the first time. So he hopes he has turned the corner. How would a doctor initially know someone needs more time with the catheter, or is a slower healer, or has developed more scar tissue than average? Seems like it would be hard to know that in advance. Is there any medication that could help with this, reduce inflammation perhaps? Seems like it would be pretty hard to remove excess scar tissue. (Don't even want to think about that!)

[TWTJr in reply to sturn]

Yes, I am an interventional radiologist, and have had similar issues. If he has not had radiation, it is likely in due time his obstructive symptoms will settle down. (likely scar tissue. ) Urologists can do procedures using either laser or a radial urethrotomy where a blade is used to provide a more lasting opening. Doing less is better. The more intervention that is done, the more likely he will "provoke" more scar tissue. Try to get him to learn self catheterization, as delicately as possible. Any catheter induces some mucosal irritation, and edema, both resulting in a greater degree of stenosis. Have his urologist instruct him on the procedure.

[sturn in reply to TWTJr]

I read your profile and saw that you're a radiologist. I'm a former oncology sales rep, and I knew you sounded "professional." Your first reply was a bit scary to me, to think that it could be a chronic issue. He is only 50 and needs to get back to work and I can't imagine dealing with this for years to come! We're hopeful it will clear up on its own with time. We'll have to explore self catherization. Thanks so much for this information.

[Fairway]

I had a similar problem necessitating a visit to the ER. It turned out that my bladder was clogged with blood from the surgery and couldn't drain.

[sturn in reply to Fairway]

Thanks for your input. I don't think that's my son's problem. Never realized so many things could possibly occur!

[donovan0932]

I have a technique that works for me.Turn and sit for 10-20 seconds then try again .May have to do it twice but it seems to open the stream .For me anyway .Good luck

[sturn in reply to donovan0932]

Will definitely have my son give it a try! Thanks!

[sturn in reply to donovan0932]

Do you think you could explain your method in a little more detail? Not quite sure what you mean.

[donovan0932 in reply to sturn]

yes it was a little brief and although it is simple it works for me .

I am a 12 year survivor ,now on a clinical trial of Xtandi /Keytruda combination .

I had trouble after sitting and especially lying prone at night ,then one night while standing and attempting to urinate i sat down ,either in frustration or to think it thru ? When i stood and made another attempt i had flow .

i use this method two or three time a night and it always works ,

hope this helps your son .

[sturn in reply to donovan0932]

Got it! I think you may be on to something! My son reports today that things are going much better for the past day or two.

[j-o-h-n]

As far as a cystoscopy is concerned tell you son it's no biggie... Sounds worse than it is, trust me I've had a few. (Also depends on the doctor, hopefully he's not a butcher).

Good Luck, Good Health and Good Humor.

j-o-h-n Monday 04/29/2019 10:06 PM DST

[sturn in reply to j-o-h-n]

Good to know. Let's hope it doesn't come to that but it may. But he is doing better the past few days. Thanks, John.

[j-o-h-n]

Good News....

Good Luck, Good Health and Good Humor.

j-o-h-n Tuesday 04/30/2019 6:39 PM DST