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Suggest remedy for urinary retention post cardiac catheterization

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Dr. Saddiq Ulabidin

General & Family Physician

Practicing since :2011

Answered : 2149 Questions

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Posted on Wed, 4 Nov 2015 in General Health
Question: I am unable to urinate on my own since I went to the hospital for chest pains.
I had a heart cat, and after I vomited after they gave me a bunch of pills on an empty stomach. My femoral artery opened up during vomiting and the blood went under my skin and covered my private areas. Next day doctor looked at it and wanted a cat scan to make sure there was no blood clot. While doing the scan they noticed my bladder was full. As soon as I got back to my room I was catherized and 1800 ml were removed. 1791ml of urine and 99 Ml of blood. Since then I have been unable to urinate on my own.
After the heart XXXXXXX they were hanging bags of saleen and antibiotics, morphine etc, to flust my system of the radition of the heart XXXXXXX but they failed to check if anything was coming out.
Since nothing was coming out it all went to my bladder and at that point of 1800ml which is XXXXXXX for a bladder, my urologist told me the capillaries inside my bladder started bursting. I have been treated by a urologist for 4months now and she wants to do a TuRP. But my cadioligist says I can't have any surgery for 6 months. Meanwhile I am urinating via in-out catherizes which I do here at home.
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Answered by Dr. Saddiq Ulabidin 1 hour later
Brief Answer:
Surgery can wait until cardiologist gives fitness, use catheters for urine

Detailed Answer:
Hi! Welcome to health care magic. It is sad to know what you have gone through and you had to suffer the rare complications of certain life saving procedures unfortunately.

Based on the history you have shared, the first thing which I need to clarify is that, cardiac catheterization was need of time at your presenting complaints, as cardiologist must have weighed the risks vs benefits.

After cardiac intervention or angiography, two of its complications which hit you were, hematoma around femoral puncture site and second was contrast induced nephropathy if I am not wrong. It got worsened by the fact that when extra fluids were given to wash out the contrast out of your system, the already present obstruction in bladder outflow worsened the situation. The stretch on bladder might have caused those symptoms as urologist told you already.

Now is the question of what to do next. Firstly it would be good if you can monitor status of urea creatinine levels in the blood and to evaluate whether contrast induced changes have been reverted back or not, as that is of prompt importance to save kidney in the setting of obstructive uropathy.

Second main thing is to get regular evaluation by a cardiologist yo monitor heart functions as that is more important in your setting.

Lastly, though the issue of urination through catheter is definitely a troublesome for you, but before going to the option of TURP cardiac fitness is essential to sustain the after myths of surgery and anesthesia. Meanwhile, keep in contact with urologist for supportive measures and keep the catheter. For long term usage silicon catheters are preferred over latex ones. Keep sending cultures and urinalysis repeatedly as such catheters can cause repeated urinary tract infections. If any such finding is noticed, prompt treatment with antibiotics should be ensured.

Hoping you a speedy recovery. I hope this answered your query, if you don't have any more questions, please close the discussion. Regards
Above answer was peer-reviewed by : Dr. Neel Kudchadkar
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Follow up: Dr. Saddiq Ulabidin 4 hours later
The cardiologist at the last visit said my heart was fine and there was no damage.
He opened one coronary artery which was 99% blocked and put two stints in it.
On a second artery which was 72% blocked he did an angioplasty. I am currently on 2 blood thinners, Eloquis, and Plavix.
My problem with doing a turp is the urologist want to use general anesthia. The last time I was operated for an inguinal hernia and general anesthesia was used, they could not wake me up. The Anestesologist was pounding on my chest. She said it took them 45 minutes before they got me off the respitator, and the when the tube was taken out it was full o mucus. At the preop I told the lady I had a bad cold but she said I would be all right. So now I have a fear of using general.

I asked about a spinal and around this area they are reluctant to use that,because it take about 6 hours to wear off. So now, I was wondering about using what a women has when she has a baby. I also heard they use this for lower back treatments. It's called an epidural. Could this be used if I have a TURP
doctor
Answered by Dr. Saddiq Ulabidin 18 hours later
Brief Answer:
Epidural can be ineffective, spinal can be given

Detailed Answer:
Hi! Thanks for sharing all the details.

In my opinion there is no absolute contraindication to use spinal anesthesia in your condition, except for the use of blood thinners, which would definitely needed to be stoped few days before surgery. Epidural can be less effective.

BPH can already be present, and can be missed in ultrasound or some clot in bladder would have exacerbated your symptoms so acutely. Femoral artery leak remains outside bladder and can compress on the outside structures but this compression upto this extent that it can block urethral outflow is practically impossible. Similarly constipation of this intensity causing urinary blockage is rarely possible. in any case, whatever the reason might be, the TURP will need anesthesia fitness and for that your cardiac status is most important.

Hope this has answered your query, if you have any more questions, feel free to ask. Regards.


Above answer was peer-reviewed by : Dr. Vinay Bhardwaj
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