Urinary Retention

[Trooper]

I'm looking to get your thoughts about an issue I am having to see if I should be doing anything differently and to get your experiences - hopefully I am not alone. I'm 67 and before October of last year I would have said I was in very good health -- very active with no significant health issues other than mild BPH for which I was taking Flomax/tamulosin.

In October, 20204 DW took me to the ER for intense lower back pain. A few weeks prior to that I had been moving some furniture and it caused some minor pain for which I was seeing a chiropractor. During the ER visit the nurse palpitated my abdomen and felt that my bladder was full and asked if I needed to go to the bathroom. I said 'yes", urinated, and returned to the table. The nurse felt around again and I was still fairly full. She performed an ultrasound of the bladder and it showed about 400cc. She gave me two choices: try and urinate again or be catheterized. I tried. couldn't so I was somewhat painfully catheterized. More on the catheterization pain later.

After X-Rays, CT scans and an MRI I was discharged with a diagnosis of a herniated disk and urinary retention. I have been seeing a spine doctor for the disk and it has been resolving fairly well. Not so much with the urinary retention. I couldn't get in to see my urologist for about 10 days so I wore the catheter during that time. My urologist removed the catheter but wanted me to go home, drink a bunch of water, come back in the afternoon, urinate to see whether I could fully void. I could, but not enough - I was still retaining 300-400cc. In went the catheter again. My urologist doubled the Flomax dose.

Two weeks later I had Urodynamics test which was fairly normal except that I was still not completely voiding afterwards, but enough to have the catheter removed. Began taking finasteride. The following week I was scheduled for a cystoscopy which could not be performed because I was in excruciating pain upon insertion of the catheter. The urologist ordered a cystoscopy under anesthesia, during which a dilation of the urethra and a meatotomy would be performed. The latter procedure widen the meatus, the very last part of the urinary tract, which for me was abnormally narrow - hence the abnormal pain during catheterization and scope insertion. This surgery went well, I went back the next day to have the catheter removed and a bladder ultrasound. The ultrasound result was great 41cc - so I thought I was cured of retention. Also the cystoscopy showed no signs of anything amiss with the bladder, except for it appearing a bit more muscular than normal due its working harder over the years. I was also told to self-perform a meatal dilation with a device known as a "whale bone" two times per week at home. This is to keep meatus open and prevent scarring from the surgery.

At a follow-up appointment in late December I had another ultrasound at which I showed 325 cc of urine. Ugh. My urologist switched me from Flomax to Alfusosin, as he has seen better results with Alfusosin. He also measured the size of my prostate at 65-75 cc. Two days ago I went for another ultrasound and the bladder still indicated 400 cc despite the change in medication. We discussed either intermittent self-catheterization or a prostate reduction procedure. For the latter he mentioned TURP and HoLep. A few months back I researched both just in case and decided that the HoLEp was a good option - less invasive and not dependent upon prostate size. I left the appointment expecting a call from a surgeon this week.

One thing to point out is that after urination I feel like I have emptied my bladder, despite the ultrasound readings showing otherwise. I do not know how long the retention has been going on. Also, my PSA is low (between 0.9 and 1.1) so we have ruled out prostate cancer. Any thoughts on what could be causing the retention, and/or why I am not feeling full after urination? I am not convinced it's a clear cut case of BPH, although I would love to have the procedure and be done with this.

Thanks for reading and for any advice.

 

[Sunset]

I have no advice, but applaud your brave description.

I have found sometimes that I go pee standing up and a short time later have to go again.

I've also found if sitting on the toilet seat, I go pee, and then a couple of minutes later, with some concentration on relaxing, I pee some more. This is not trying to squeeze out the pee but the opposite trying to be calm and relaxed. I believe that squeezing out the bladder, ends up causing issues later in life, so I avoid that.

I wonder OP if sitting to pee would work better.

My other thought, is I had an Uncle ~75 who felt ill and they took him to the hospital, where it was found he had an immense amount of pee in his bladder, I think they measured it in quarts, and it was black when catheterized, as it had all sorts of stuff probably bacteria growing in it. He recovered, but it amazed me that this could happen.

 

[braumeister]

Sounds to me like a TURP would work for you. I had one about five years ago and everything is still good.

 

[aja8888]

I'm 81 and on Tamsulosin. I have a low PSA (under 1.0) and pee a lot (I also drink a lot of liquids). But it's not too bad and am going through the same with peeing, then 30 minutes later, going again. At night, I get up on average two times to go. Maybe old age is a consideration as to why this stuff happens?

 

[MRG]

I was recently informed that my cervical stenosis is sometimes a cause of urinary retention. Any known neck issues?

 

[Trooper]

I wonder OP if sitting to pee would work better.

Thanks Sunset. I have tried both stnding and sitting...usually standing during the day and sitting at night. I have not tried the relaxation technique however. I'm usually up as soon as the stream stops.

I was recently informed that my cervical stenosis is sometimes a cause of urinary retention. Any known neck issues?

I haven't had any neck issues, but I do wonder if the L3/L4 herniation affected nerves in the bladder region. Neither urologist nor spine doctor have said definitively.

 

[Trooper]

Maybe old age is a consideration as to why this stuff happens?

I've thought about this and honestly wish it's just my age. But I have also been told that carrying around 300-400 cc of urine in the bladder can cause renal failure or UTIs. How does anyone know whether they're retaining if they don't have an ultrasound?

 

[aja8888]

I've thought about this and honestly wish it's just my age. But I have also been told that carrying around 300-400 cc of urine in the bladder can cause renal failure. How does anyone know whether they're retaining if they don't have an ultrasound?

I guess you are right with that.

 

[bjorn2bwild]

I can relate with a very similar story, although my long standing back condition (L5/S1) was never considered a factor.
Drugs were not effective, it was definitely BPH with most of the growth concentrated at the bladder neck.
Rezum and TURP were the only locally offered options.
My wife being connected in the medical community could not get a good recommendation so I looked elsewhere.
Ultimately deciding on HoLEP down your way at the Mayo Clinic in Scottsdale/Phoenix.
As a traveler, they scheduled all the pre-op procedures the day before surgery which was brutal.
No sedation was offered for the urodynamic/scoping tests. A firm 10 on the ouch scale!
The expert urologist/surgeon described my case as difficult.
Even so, the procedure took less than an hour.
Most of his patients go home the same day, alas I am a bleeder so spent the night under observation.
The following day, the catheter was pulled, I passed the pee test and was sent on my way.
I would not like to go through that ordeal again, glad I chose HoLEP.

 

[RetiredHappy]

Maybe you can explore if it is related to your herniated disk issue. My cousin has herniated disk and has issue emptying his bladder due to this condition. He has a take a pill each time he wants to pee, otherwise he can't or has difficulty emptying his bladder.

His spine condition is pretty serious and one foot gets numbed.

 

[Trooper]

I can relate with a very similar story...

Thanks for sharing, bjorn. Very relevant to me as my urologist is a part of Mayo and, if I elect HoLEP it would be performed here at Mayo's Phoenix hospital. I have a few questions for you, if you don't mind:

1. What condition brought you to seek a BPH procedure? Was it 'simply' BPH or did you have retention as well? I ask because I don't fully understand if all BPH sufferers also suffer from retention.
2. I'm guessing I won't need the pre-op procedures you had since I have already had the enjoyable urodynamics test and the cystoscopy. Any other pre-op procedures required?
3. How long ago was your HoLEP procedure?
4. Was it effective in eliminating your issue? Have you had to see a urologist since?

5. it was definitely BPH with most of the growth concentrated at the bladder neck

   Interesting. I just had a discussion the other evening with someone who said the location of the prostrate relative to the bladder and urethra was just as important the size of the prostrate for eliminating symptoms. How did your medical team determine where the growth was?
6. What was the name of the surgeon who performed the HoLEP procedure?
   

 

[bjorn2bwild]

Thanks for sharing, bjorn. Very relevant to me as my urologist is a part of Mayo and, if I elect HoLEP it would be performed here at Mayo's Phoenix hospital. I have a few questions for you, if you don't mind:

1. What condition brought you to seek a BPH procedure? Was it 'simply' BPH or did you have retention as well? I ask because I don't fully understand if all BPH sufferers also suffer from retention.
2. I'm guessing I won't need the pre-op procedures you had since I have already had the enjoyable urodynamics test and the cystoscopy. Any other pre-op procedures required?
3. How long ago was your HoLEP procedure?
4. Was it effective in eliminating your issue? Have you had to see a urologist since?
5. 
   Interesting. I just had a discussion the other evening with someone who said the location of the prostrate relative to the bladder and urethra was just as important the size of the prostrate for eliminating symptoms. How did your medical team determine where the growth was?
6. What was the name of the surgeon who performed the HoLEP procedure?

1. I had the classic symptoms of BPH which gradually worsened over many years to the point of almost full retention.
I was not aware of the post void retention until I was tested by my first local urologist in early 2023.
2 & 5. There were blood draws, urinalysis/culture to clear any UTI and a rectal ultrasound (not fun) to define shape and size.
3. It will be two years in June.
6. Dr Mitchell Humphreys. Two years ago he was the chair of the urology unit with 4,000+ HoLEP procedures of experience.
I was told that I would need to stick with my primary urologist throughout, he was great.
PS - 4. Yes, very happy with the results. No, I have not needed to see a urologist post op.

 

[bmcgonig]

Thanks for sharing, bjorn. Very relevant to me as my urologist is a part of Mayo and, if I elect HoLEP it would be performed here at Mayo's Phoenix hospital. I have a few questions for you, if you don't mind:

1. What condition brought you to seek a BPH procedure? Was it 'simply' BPH or did you have retention as well? I ask because I don't fully understand if all BPH sufferers also suffer from retention.
2. I'm guessing I won't need the pre-op procedures you had since I have already had the enjoyable urodynamics test and the cystoscopy. Any other pre-op procedures required?
3. How long ago was your HoLEP procedure?
4. Was it effective in eliminating your issue? Have you had to see a urologist since?
5. 
   Interesting. I just had a discussion the other evening with someone who said the location of the prostrate relative to the bladder and urethra was just as important the size of the prostrate for eliminating symptoms. How did your medical team determine where the growth was?
6. What was the name of the surgeon who performed the HoLEP procedure?

Just to answer number 1. I have BPH with a prostate of 60cc. No retention issues. Using Finasteride

 

[Koolau]

The apparent disk issue at time of diagnosis of 400 mL retention (without recognition of it) suggests a nerve issue. Surprised the docs have not looked more carefully in that direction (unless I missed it). Best luck going forward. Keep us posted, please. We are now invested.

 

[grasshopper]

Here is a twist unrelated or not, I had the regular get up to pee twice a night. Then I had robotic hernia surgery with a block. Retention went downhill quick from there.

 

[Trooper]

The apparent disk issue at time of diagnosis of 400 mL retention (without recognition of it) suggests a nerve issue. Surprised the docs have not looked more carefully in that direction (unless I missed it). Best luck going forward. Keep us posted, please. We are now invested.

Will do. I keep wondering whether the two are related, but also struggle how causation would be determined. I have no data as to when the retention started. If I had the HoLEP surgery and the retention persisted, that would confirm a nerve issue, no? I would hate to have surgery just to eliminate a cause, but perhaps the surgery would be beneficial in prostate size reduction anyway. Incidentally I sent the nerve question to my urologist over the weekend through the portal.

Here is a twist unrelated or not, I had the regular get up to pee twice a night. Then I had robotic hernia surgery with a block. Retention went downhill quick from there.

Was your hernia surgery before or after your HoLEP? What was the "block" a pain suppressant?

 

[grasshopper]

Was your hernia surgery before or after your HoLEP? What was the "block" a pain suppressant?

The hernia surgery started the urine retention. Made me look a transversus abdominis plane (TAP) block, never knew has nothing to do with your back.

 

[Sunset]

Maybe you can explore if it is related to your herniated disk issue. My cousin has herniated disk and has issue emptying his bladder due to this condition. He has a take a pill each time he wants to pee, otherwise he can't or has difficulty emptying his bladder.

His spine condition is pretty serious and one foot gets numbed.

I had leg go numb due to lower back spine injury, after years of suffering, finally went for spinal fusion. Life was good again.
He should look into it, if not already done.
Just be extremely careful when healing to wear the brace and not twist or lift so bones can grow properly.

 

[frayne]

Just catching up on this thread. A little backstory: Last year, I went into urinary retention, experiencing severe pain down my left leg. I spent a weekend in the hospital undergoing a CT scan, X-rays, an MRI, and plenty of poking and prodding. The diagnosis was an enlarged prostate, which caused my bladder to swell and impinge on nerves in my back. (I had a double fusion in 2019 at L4, L5, and S1.)

I was sent home with a prescription for Tamsulosin and a Foley catheter. A couple of weeks later, I finally got in to see my urologist. When the Foley was removed, I couldn't pass the voiding test, so I was sent home with eighteen different sizes and styles of catheters to self-catheterize until I could undergo a scope. The scope revealed that everything was normal except for a urethral restriction through the prostate.

I was given the option of undergoing the HoLEP procedure or continuing to self-catheterize. A year later, at 74, I’m still self-catheterizing three to four times a day and taking 5 mg of Cialis. I’ve researched different prostate procedures, and if I decide to move forward, I’ll opt for HoLEP. For now, though, I’m in no hurry to get it done and self catching is not a big deal or quality of life issue. If I were younger and still a working stiff, I'd have the procedure done.

 

[MrsHaloFIRE]

im a chick but I will offer: husband had the surgery described and is much improved. When I had a c section i had a spinal injection and afterwards for a couple weeks even though i was living my life I could not tell my bladder was full. no urge to pee. They did the injection about midback. So Im postulating either the nerves were still numb or temporarily damaged during the shot (yes it was a shot). So You could have pinched off nerves from the hernation. Anyhoo I peed by time not by urge until that passed. I encourage you to get the surgery it was life changing for my husband.

 

[aja8888]

im a chick but I will offer: husband had the surgery described and is much improved. When I had a c section i had a spinal injection and afterwards for a couple weeks even though i was living my life I could not tell my bladder was full. no urge to pee. They did the injection about midback. So Im postulating either the nerves were still numb or temporarily damaged during the shot (yes it was a shot). So You could have pinched off nerves from the hernation. Anyhoo I peed by time not by urge until that passed. I encourage you to get the surgery it was life changing for my husband.

What exact surgery are you referring to here?

 

[MrsHaloFIRE]

laser enucleation. TURP adjacent for BPH benign prostatic hypertropthy with LUTS urinary retention

 

[Trooper]

Just catching up on this thread. A little backstory: Last year, I went into urinary retention, experiencing severe pain down my left leg. I spent a weekend in the hospital undergoing a CT scan, X-rays, an MRI, and plenty of poking and prodding. The diagnosis was an enlarged prostate, which caused my bladder to swell and impinge on nerves in my back. (I had a double fusion in 2019 at L4, L5, and S1.)

Thanks for sharing. Your experience really makes this seem like a "chicken or the egg" scenario. In your case the doctors believed the prostate size caused the bladder nerve impingement , leading to retention. I was starting to believe that my back issue (I also had pain down my leg at the time of disk herniation) is causing my retention.

 

[marko]

The apparent disk issue at time of diagnosis of 400 mL retention (without recognition of it) suggests a nerve issue. Surprised the docs have not looked more carefully in that direction (unless I missed it). Best luck going forward. Keep us posted, please. We are now invested.

When I read this post on Sunday my first thought was a connection between the back and the retention.

I've had L5, L4 problems my whole adult life and whenever it kicks up, I end up with severe constipation until it subsides. Sometimes after a chiropractor adjusts me I'll have to quickly get home lest I have an "accident"

 

[PlayinwithFIRE]

Thank you all for your candidness. Within the last year or so, I no longer can -feel- when my bladder is full, empty or otherwise. Went to urologist, who checked emptying by ultrasound-which was fine. PSA was fine. Prostae exam...memory is fuzzy but was fine perhaps 1 of 3 segments slightly enlarged. Definitely experiencing lower pressure streams and some difficulty getting going.

Told to come back in a year. I have had sciatica from time to time. just don't know what i should be considering as next step besides "wait a year". Its kind of annoying to have to make mental notes to go off and check during workday.

pwf