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DrK99, MD
Category: Urology
Satisfied Customers: 4405
Experience:  Board certified ob gyn with 20 years experience
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I am 66 YO Male w DM and diabetic neuropathy.. After US

Customer Question

Hello. I am 66 YO Male w DM and diabetic neuropathy.. After US showed 2 liters of urine in bladder (and no urge to void) cystoscopy showed "no growths,no ureter stints needed, and questionable permanent bladder damage, I was told i have a "high bladder neck" and recommend a PVP greenlaser. With minimal symptoms, and normal for age prostate size, I am puzzeled and wonder if possibly neurogenic bladder or PBNO. Urodynamic studies done (non-video) and wondering if alpha blockers and/or watchful waiting are more prudent at this time. What are the key questions or tests to resolve diagnosis and decide the least invasive & longest resolution treatment. I dont (yet ) want a TURP. I want to remove foue week voley and try CIC for a week or two. If i void naturally, and immediate CIC shows no significant residiual urine volume, does that not suggest watchful waiting is the most prudent course? Even if uroLift might not be recomended, it can be reversed and other PVP or other surgery could then be done. (sorry I do not yet have copy oy urodynamic study results.). Thanks in advance for Your thoughts... John P
JA: Any pain or burning sensation while urinating? What color is your urine?
Customer: I am a Lab Tech... Urine is pale yellow, no RBCs on 15 min settling. No pain on voiding... really only symptom was weak stream (i thought normal for age) and not knowing without looking if i was finished. only incontenance was on first awakening & hurring to bathroom, i might dribble a drop or three...
JA: How long have you had the pain? What seems to make the pain better or worse?
Customer: dont have any pain...
JA: Anything else in your medical history you think the doctor should know?
Customer: History of DVT in 2009, on warfarin 6 mg/day, Testosterone Rx self inject IM 100 units every 15 days, Beta sitosterol supplements stopped 3 to 4 / night voiding (with DM diagnosis... NO trips to pee for two years after started beta sitosterol 3 years ago. now suspended this supplement...
Submitted: 4 months ago.
Category: Urology
Expert:  DrK99 replied 4 months ago.
2 liters of urine is urinary retention. In the face of diabetes, it points to neurogenic bladder. Your proposal of a trial of a foley followed by intermittent self catheterization sounds like a good plan. Overdistention of the bladder further damages the nerves, and this may allow the bladder time to recover.