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Dr. Tharun
Dr. Tharun, Urology Resident
Category: Urology
Satisfied Customers: 3565
Experience:  MBBS, DNB surgery and presently working as Urology resident towards the degree of Urologist.
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it is now 3 months since i had laser surgery to treat my prostate,

Resolved Question:

it is now 3 months since i had laser surgery to treat my prostate, and have had a catheter in order for me to pass urine. I am becoming increasingly concerned at the seemingly lack of attention from the urological team treating me and seem to be facing life with a catheter for the rest of my life. I am 75 years old but prior to this was still able to enjoy a great sex life, this is not my prime concern tho,having the worry of why I still cannot pass urine in a normal manner together with the often sharp pain i get and the thought of the necessity of having the catheter replaced from time to time being my main concerns,
With thanks for any help or advice you may be able to give me,
Ian Currie.
Submitted: 11 months ago.
Category: Urology
Expert:  Dr. Tharun replied 11 months ago.
HI Ian,

I am Dr.Tharun and I will helping you with your question today.
Sorry to hear about your problem you are facing.

Can you tell me about your urination pattern before the surgery - flow, pain, night habits etc?

What happens when the catheter is removed - Do you get pain and still not able to void?

Or you don't have any sensations at all?

Are you diabetic ?

Any spine problems ?

Did you have urinary problems for long time before the surgery ?

Have you done an Urodynamic study?

Please let me know.

Dr.Tharun.
Customer: replied 11 months ago.

Hi Dr.Tharun,


thank-you for your reply and will answer your questions in order,


 


before surgery I was having usual problems with urinating associated with an enlarged prostate, no pain,and having to get up maybe twice in the night.


 


When the catheter is removed there is no undue pain but i get no urge to pass urine at all apart if really forcing I get a small amount to come thru.


 


does give me pain to try and void


 


i am not a diabetic


 


The surgery was given with a spinal anaesthetic no other spinal problems


 


I have not been told about a Urodynamic study


 


 


Ian.


 


 


 


 


, no other spinal problems


 


 


 


 


 


 


 

Expert:  Dr. Tharun replied 11 months ago.
Hi Ian,

There are two reasons why a person cannot pass urine after prostate surgery.

One is residual prostate which is still causing the block or obstruction.

Second reason is a weak bladder which lacks the power to pump the urine out. Your symptoms suggest that you may have a weak bladder.

If it had been a residual prostate,the bladder would be normal and you will have the normal urge to void once the catheter is removed. And once the bladder is full it is very painful even when you are not trying to pass urine.

But a weak bladder does not create an urge nor cause pain at rest. Sometimes it could be a mix of both the features.
The reason for this condition is usually long standing prostate block against which the bladder had been working on; ultimately resulting in its failure and weakness.So resting the bladder is the best treatment it.

Other causes could be diabetes, spine problems, previous pelvic surgeries( not the LASER one).Old age can contribute to this problem too.

The only way to diagnose this condition and to know whether the bladder is weak is to do an Urodynamic study.As it has been 3 months post surgery, you are an ideal candidate for this procedure.

This study involves filling the bladder with water and then measuring the bladder pressures with fine tubes through the urethra. If enough pressure is not generated then it means there is weakness in the bladder muscles.
There is no specific treatment for this condition than waiting it out till it improves of its own.Sometimes improvements have been noted up to 1 year after acquiring this condition.Till that time bladder has to be kept empty either by an indwelling catheter or intermittent catheterization( tube is put every 4- 6 hours).
The only medication which has been useful for this condition is bethenacol. But results are not overwhelming with this drug.

I would advise you to discuss the option of Urodynamic study with your doctor and come to a diagnosis as soon as possible and then work towards the management.

I hope this helps you understand your problem in a little better way than before.
If you have any doubts, please let me know.

Dr.Tharun.
Dr. Tharun, Urology Resident
Category: Urology
Satisfied Customers: 3565
Experience: MBBS, DNB surgery and presently working as Urology resident towards the degree of Urologist.
Dr. Tharun and other Urology Specialists are ready to help you
Customer: replied 11 months ago.

Thank-you for your reply to my enquiry Dr. Tharun. Seems that I just need to be patient but will certainly fololw up the option you suggest about the urodynamic study. It does seem however that perhaps i should have had a little more information given to me re. the possible outcome of the proceeduer i received, the thought of needing these self catheterisations is rather scary.


 


With thanks,


Ian.

Expert:  Dr. Tharun replied 11 months ago.
I understand your apprehension regarding the possibility of self catheterization in future.

Surgery will not weaken the bladder or paralyze it, since it is done on a gland below the bladder.But the water filling into the bladder during the procedure could just tilt the balance to the other side of the spectrum. Three months is not enough for this condition to develop. It is a slow process.The bladder had been weak for some time. The surgery and the stress of it just pushed it across the border and unmasked the problem completely.
I hope everything improves for the best.

Dr.Tharun.

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