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Not able to pass urine. 90% got blocked. Had undergone pyloplasty for left kidney. Advise?

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Not able to pass urine. 90% got blocked.
Posted Thu, 20 Jun 2013 in Urinary and Bladder Problems
 
 
Answered by Dr. V. Sasanka 6 hours later
Hi,
I wish you had provided some more details, but from the looks of it, you might need to go to Emergency room of a hospital urgently, where it will be determined if you have urine in your bladder which is obstructed, or is there low production of urine, in which case the treatment will be much more different.
Usually patients do mention that they have had slow flow of urine for some months before retention of urine develops.
It is unlikely that your previous pyeloplasty surgery is an issue here unless the opposite kidney is also affected by some disease process or if there was a catheter in your urinary passage at that time which resulted in a stricture of urethra which is a narrowing of your urinary passage which can cause the kind of problem that you seem to have.
I suggest at the least you have an ultrasound scan of your bladder and kidneys done which might pick up a urinary stone, along with an estimation of your kidney function by means of a test called serum Creatinine. If there is urine in your bladder which is not coming out, you might need a procedure called 'catheterization' where a slender tube is passed into your urinary passage through which urinary bladder pressure will get relieved.
The actual treatment will eventually depend on the disease which has caused the urine to get blocked.
Hope I have been able to help you.
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Follow-up: Not able to pass urine. 90% got blocked. Had undergone pyloplasty for left kidney. Advise? 14 hours later
Hi,

Yesterday I consulted the doctor and he asked me to undergo following test to start the treatment.

CBC, RBC, Serum creatinine, HbAC, Urine routine, Urine C/S, USG and Uroflow meter.

All test are completed except the uroflow meter ( due to insufficient flow the machine not able to read ).

Expected the reports by today evening, after consulting the Doctor will post you the outcome.


 
 
Answered by Dr. V. Sasanka 29 minutes later
Hi,
You are welcome to contact me with reports. If there is insufficient volume for uroflowmetry, it indicates that you might have been dehydrated, and hopefully once you replenish your body with fluids, urine output automatically improves. The blood reports are important, and if your Serum Creatinine is within normal limits, you should be comfortable very soon.
Regards.
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Follow-up: Not able to pass urine. 90% got blocked. Had undergone pyloplasty for left kidney. Advise? 8 minutes later
Hi,

Thanks for your reply Sir,

At the time of Uroflow meter test, my bladder was full. But flow was very less (thin line ) and it also took almost 5min to empty.

So much of pressure is building at the tip while urinating but outcome is very less. Some times one or two drops of puss is see on the tip ( toady morning ).

Regards,
 
 
Answered by Dr. V. Sasanka 6 minutes later
Hi, this is what I means when i said there is a possibility that your urethral passage has become narrow - we call it stricture of urethra, and often the patient gives history of having been catheterized earlier, as I guess you must have been when you had your pyeloplasty surgery.
The way to confirm is by means of a special X-ray called RGU - Retrograde Urethrogram - which will involve sending 'contrast dye' into your urinary passage and taking an X-ray to find out the level of obstruction which is usually well delineated. This should preferably done under antibiotic cover as you mentioned that you noticed pus at the tip of penis today morning.
Once an RGU is done, treatment will depend on the findings. You might require 'urethrotomy' which will nicely widen the passage of urination.
Regards.
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Follow-up: Not able to pass urine. 90% got blocked. Had undergone pyloplasty for left kidney. Advise? 6 hours later
Hi,

Reports attached for your reference. Doctor askled to undergo RGU and MCU (planned tomorrow ) to start the treatment.

Regards,
 
 
Answered by Dr. V. Sasanka 1 hour later
Hi,
I am afraid the reports have not been attached.
However, I shall be quite happy to give an opinion once your RGU and MCU tests are completed.
Above answer was peer-reviewed by
 
Follow-up: Not able to pass urine. 90% got blocked. Had undergone pyloplasty for left kidney. Advise? 27 minutes later
Hi,

Re attached.

Regards,
 
 
Answered by Dr. V. Sasanka 8 minutes later
Hi,
I had a look at all your reports.
The blood tests are fairly normal.
The USG was suggestive of chronic bladder otlet obstruction evidenced by mild baldder wall thickening, and significant post void residue, -143cc is high - anything over 50cc in an average Indian male should be carefully considered.
All these generally are suggestive of stricture urethra. RGU will be the test to be done. I am almost certain that MCU will be only an attempt and a waste of time and effort and money, but if your local urologist insists on it, well, you go ahead.
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Follow-up: Not able to pass urine. 90% got blocked. Had undergone pyloplasty for left kidney. Advise? 5 minutes later
Hi,

Thanks for your support. Will post you after the RGU report comes.


Attached RGU/MCU report and culture report.

Yesterday night only 40% of blockage is gone. After todays MCU test, i'am able to pass urine without any problem (no blockage at all ).

Couldn't able to XXXXXXX the doctor now.

Regards,
 
 
Answered by Dr. V. Sasanka 24 hours later
HI,
Had a look at all your reports. I guess you must be having a narrow area in the tip of the urine passage - we call this the urethral meatus - if this gets narrowed, urinary stream becomes slower. The good news is that the rest of the urethra is normal. The reason why you find that you have no blockage now is that the passage would have become larger when they inserted the tube to inject contrast at the time of your MCU / RGU. I suggest that you repeat a Uroflowmetry now that you find that flow is better, and depending on what we find here, we can plan further treatment. If the flow is still considerably slow, i.e less than 10ml/sec of peak flow rate, you will benefit from meatal dilataion or meatoplasty.
Regards.
Above answer was peer-reviewed by
 
Follow-up: Not able to pass urine. 90% got blocked. Had undergone pyloplasty for left kidney. Advise? 44 hours later
Hi,

Attached uroflow test report.

Met the Doctor today. He said that metoplasty to be done (no emergency as of now after seeing the uroflow test report he said). He told me to plan the surgery when ever i'm free ( he also mentioned that i need to be admitted in hospital for 3 to 4 days and atleast 2 weeks rest at home ).

Please suggest how to proceed further. Is it realy i need to take 2 to 3 weeks leave for this surgery.

 
 
Answered by Dr. V. Sasanka 3 hours later
Hi,
The decision to perform meatoplasty is one which depends on the nature of skin surrounding the meatus, and any changes in the rest of urethra. The reason is - there is an entity that affects the urethra in some men called 'balanitis xerotica obliterans' where whatever procedure is performed, the condition will continue to progress. In such a case, a simple enlargement of the meatus by a meatotomy (the meatus is incised, and the patient is instructed on ways to keep it open) will be more useful, less expensive, and eventually yield the same result. Meatoplasty, though a simple procedure, will not be really useful in cases of BXO.
After the meatoplasty procedure we leave a catheter through the urinary passage for 5-7 days depending on the severity of the disease, and this might have prompted your urologist to recommend a leave for 2 weeks in which you will not exert yourself.
At this moment, your uroflow pattern is not one of obstruction - there is no doubt about it. So you need not take a decision in a hurry, but can base it on advice from more seasoned persons and academicians. You can try a place like St.John's, considering that you are in Bengaluru. You might have some inconvenience in that it is not a corporate hospital, but it might prove worth your while. If they also recommend that you undergo meatoplasty, then you know that the decision you have taken is a good one.
Hope I have been able to help you.
All the best.
Above answer was peer-reviewed by
 
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