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Urinary Disorders

Urinary Retention After Procedure

02/24/2009

Question:

I`m experiencing Post-Op urinary retention problems from a HoLAP procedure. The procedure itself went well - no blood in urine, or infection. About 95% of the prostate was ablated. I was back home that same day wearing a catheter. But, total retention occurred after the catheter was removed the following morning. Catheterization was then continued for another 5 days. I then endured 2 days of a strained partial emptying of the bladder with an intermittent weak urine flow, and then complete retention again. Catheterization has now been continued for another week for wait and see results. My doc will perform a cystoscopy if the problem remains. Curiously, my preop cyctoscopy caused temporary retention problems that required a short catheterizaion period. A long history of classic BPH symptoms - incomplete bladder voiding, straining to start, nighttime bathroom visits, etc - necessitated the HoLAP precedure.( My condition didn`t respond to alpha blocker medication ). I`m 70 and in good health (other than the BPH problems) blood pressure fine, cholesterol 140, not obese, exersize daily, and diet. Curiously, the DRE revealed my prostate to be only mildly enlarged, and my PSA wa 3.0 . The cystoscopy revealed my baldder`s muscular tissue to be extremely over developed from my years of strained urination. Catheterization for extended periods of time can be difficult, but the fear and anxiety of the eventual uncertainty is my largest concern. I understand that there`s a number of possible causes for my problem - general trauma to bladder and urinary tract and associated swelling and nerve reactions,possible blockages, and the general anxiety and pain issues. I`ve been told that my circumstance in not the norm, and certainly I don`t expect a definitive answer to my circumstance. But, hopefully, Just an experienced and knowlegeable opinion on similar cases and how they were eventually resolved. If you can possibly comment, I`d certainly appreciate it.

Answer:

It is difficult to predict ultimate outcome of bladder function without a more information. From what you describe, it sounds like the procedure performed was appropriate. After relieving long standing prostate obstruction, it may take a while for the bladder to function and sometimes the retention may not resolve. When retention persists, this may be secondary to residual obstruction or to poor contractility of the bladder. I suggest you follow up with your Urologist to discuss.

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Response by:

Donald R Bodner, MD Donald R Bodner, MD
Professor of Urology
School of Medicine
Case Western Reserve University