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Suggest treatment for severe urinary retention

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Posted on Sat, 23 Jul 2016
Question: This is a urology question. I have a terrible urinary retention (noctaria) problem. My bladder stays 75% full and I only urinate off the top 25%. I am at night approx every two hours to urinate. I just sit there and can't go. I go back to bed and get up in another couple hours and I can urinate a small amount. This goes on all night. I don't urinate much during the day. I have had some minor success with bladder compression. I have tried Flomax but I had a reaction to it and stopped. I then went on Alfuzion and it didn't work very well and I had to stop this because it was lowering my blood pressure too much. I have a 22 year old aortic pigs valve and a pacemaker. I have edema in my feet and axles and I believe in my chest because I am having difficulty breathing and coughing. I am using a nebulizer and inhalers, recuse and Symbicort 80/4.5. I have COPD but I am not on oxygen. I have had an x ray for pnuemonia which was negative. I am trying to stay off a permenent foley but I am concerned that I am taking lasix for edema "but am I getting the fluid off"? with this urinary retention problem. My vitals are BP 155/82, PR 85, 90 O2 (with three deep breaths I can get it up to 96) I have shortness of breath. Knowing that all these systems work in concert, cardio, respiratory and kidney/urinary I feel that I need help in deciding what to do? Is a permenent foley in my life?
doctor
Answered by Dr. Dr. P. T. Patil (25 minutes later)
Brief Answer:
self Intermitent Catheterization would help to some exent .

Detailed Answer:
Hello
Thanks for your query ,based on the facts that you have posted it appears that you have chronic retention of urine with nocturnal frequency ,renal,cardiac and pulmonary problems

I shall be happy if you can post me few more details to help me in making comments on your problem.
1) Are you diabetic?
2) What is the status of your Renal Function ?
3) Have you consulted Urologist and did endoscopic evaluation ?

Your symptoms are mostly due to Senile Urethral Stenosis .There is generalized atrophy of genito urinary organs leading to narrowing of urethra ( Urethral Stenosis) which leads to incomplete emptying of bladder during every act of micturition resulting into significant amount of urine to remain in bladder what is called as Post Void Residual (PVR) urine .This PVR is the source of infection and cause for frequent urination what is called as retention with overflow..

I would suggest you to discuss with your Urologist regarding Endoscopic Calibration of urethra followed by Clean Self Intermittent Catheterization (CSIC) at home and to empty your bladder every 4-6 hours .This will help you to reduce your edema over legs and improve renal function and need to go for urination frequently ..

Second option is to put Supra Pubic Catheter (SPC) to drain the bladder with continuous closed drainage system .However this will need you to have Foley's catheter from the abdominal wall.

Get your urine culture done and take appropriate antibiotic as per culture report .

Hope I have answered your query ,please feel free to ask if you have more questions , I shall be happy to help you .
Thanks and Regards.
Dr.Patil.





Above answer was peer-reviewed by : Dr. Prasad
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Follow up: Dr. Dr. P. T. Patil (38 minutes later)
1. not diabetic
2. Renal function is fine
3. yes, and no they have not spoken about endoscopic evaluation/calibration
4 recent UTC was negative
5 do you think a 91 year old can master self catherization?
doctor
Answered by Dr. Dr. P. T. Patil (6 minutes later)
Brief Answer:
It is very simple procedure .

Detailed Answer:
Hello
Thanks for follow up .

You can discuss about Endoscopic Evaluation and calibration with your Urologist.

I over my practice of 43 years follow this regime for my elderly female patients and they do fine .

Self catheterization is very simple technique and nobody is facing any problem in doing it .

Thanks and Regards.
Dr.Patil.
Above answer was peer-reviewed by : Dr. Prasad
doctor
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Follow up: Dr. Dr. P. T. Patil (17 minutes later)
Thank you so much. You have answered my questions. You are terrific.
doctor
Answered by Dr. Dr. P. T. Patil (1 hour later)
Brief Answer:
Thanks for appreciation .

Detailed Answer:
Hello

Thanks for writing again and appreciation .

If you have time please do write your review about my suggestions and comments on the floor of the Health Care Magic .

Thanks and Regards.
Dr.Patil.

Above answer was peer-reviewed by : Dr. Arnab Banerjee
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Dr. Dr. P. T. Patil

Urologist

Practicing since :1971

Answered : 10504 Questions

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Suggest treatment for severe urinary retention

Brief Answer: self Intermitent Catheterization would help to some exent . Detailed Answer: Hello Thanks for your query ,based on the facts that you have posted it appears that you have chronic retention of urine with nocturnal frequency ,renal,cardiac and pulmonary problems I shall be happy if you can post me few more details to help me in making comments on your problem. 1) Are you diabetic? 2) What is the status of your Renal Function ? 3) Have you consulted Urologist and did endoscopic evaluation ? Your symptoms are mostly due to Senile Urethral Stenosis .There is generalized atrophy of genito urinary organs leading to narrowing of urethra ( Urethral Stenosis) which leads to incomplete emptying of bladder during every act of micturition resulting into significant amount of urine to remain in bladder what is called as Post Void Residual (PVR) urine .This PVR is the source of infection and cause for frequent urination what is called as retention with overflow.. I would suggest you to discuss with your Urologist regarding Endoscopic Calibration of urethra followed by Clean Self Intermittent Catheterization (CSIC) at home and to empty your bladder every 4-6 hours .This will help you to reduce your edema over legs and improve renal function and need to go for urination frequently .. Second option is to put Supra Pubic Catheter (SPC) to drain the bladder with continuous closed drainage system .However this will need you to have Foley's catheter from the abdominal wall. Get your urine culture done and take appropriate antibiotic as per culture report . Hope I have answered your query ,please feel free to ask if you have more questions , I shall be happy to help you . Thanks and Regards. Dr.Patil.