Failed TURP - will it recover?

[pauldhodson]

Hi Guys,

 

I was diagnosed stage IV PCa 2 years ago (April 2016 age 49) and have had chemo, ADT and now on to Enzalutamide. 

 

Over the past 6 months, my urinary function has gone from bad to non-existent and I've been self-catheterising for 5 weeks as this is the only way I could pee. On my Urologists advice, I had a TURP (Trans Urethral Resection of The Prostate) this week to enable me to pee without a catheter.

 

My Uro, said that my prostate was growing into my urethra and bladder neck and he removed a 'fair bit' of tissue. He also said he couldn't get the camera in due to the blockage and had to go to a much smaller one at first. I had the indwelling catheter removed yesterday and I am still unable to pee and I am back to self-catheterising.

 

They gave me the option of wearing an indwelling catheter for a week or self-catheterising for a week and chose to do self-catheterising. I am now wondering if I've made the right choice or if it wouldn't make any difference.

 

Has anyone else been through this? Since being home (24 hours) I've managed to pee on 25mls 2 times and that was only when my bladder was so full it hurt. I'd like to hear from anyone else who's had this experience and whether things improved over time?

 

Cheers

Paul

 

 

 

 

 

 

[Colin Glover]

Hi Paul

I sympathise with your problem but have never had it to the same degree. My prostate had swollen well into my rectum which caused problems with passing a movement and pressure on the urethra. This had the obvious effect of making the passing of urine quite difficult. Now when I went onto Lucrin some of those symptoms diminished so I refused a TURP. However a couple of months ago they returned to some degree. I spoke with my GP and she said some of her patients got relief by using Duodart or another one like it. Its main purpose is to shrink the prostate thus taking pressure off the urethra. I started it about a month ago and got relief in a day which has continued. There are some side effects but I don't suffer any visible ones as yet.

 

Hope you find a solution soon. Cheers Colin

[alanbarlee]

Hi Paul,

I'm wondering if your urologist might consider a radical prostatectomy - robotic or otherwise?

If that's not appropriate, ask about Avodart (dutasteride - a 5-alpha reductase inhibitor), which is sometimes used to shrink a large prostate gland.

Cheers,

Alan

[Charles (Chuck) Maack]

 

Dear Paul, you may want to consider information in the following:

 

Catheter use for those Experiencing Blockage of Urine from the Bladder due to Treatment Side Effects

(Saved by Prostate Cancer Mentor Charles (Chuck) Maack)

 

You may want to consider a Subrapubic Catheter.  Open and review information in this reference: https://tinyurl.com/yd3ox7tb  or

https://www.bladderandbowel.org/surgical-treatment/suprapubic-catheter/

 

As to continued use of administering self cathetering, patient Eric Sondeen provided the following information to a patient's request many years ago that I saved and passing the info on for your information since it may aid you or others having difficulty with this procedure:

 

"I've become more knowledgeable in this area of catheterization than I ever dreamed of.  I have either done intermittent or Foley (in-dwelling) caths since April (now August).  I'm cath-ing at least twice a day to keep open from my strictures now--I've previously cathed up to nine times a day for weeks.

 

Xylocaine pre-loaded gel is what paramedics, docs, and others use.  The 10cc syringe has a blunt nose on the end (no needle) and can be used in our PCa world for several applications.

 

TIP LUBRICATION:

 

You asked about the "tip" application so I'll address that.  First, anytime you use a local anesthetic to deaden sensation there is a **risk of undetected ongoing damage to the area**.  It is critical to assess that.

For that reason, on a Foley (in-dwelling) I was more likely to use a bit of Neosporin (antibiotic) or non-xylocaine surgical lubricant (Surgilube or KY).  This immediately makes a difference for me.  I carefully wash the area with soap and water first.  I also insure that the whole works is padded with a washcloth or 4x4 gauze(catheter secured by paper tape to leg or hip).

That reduces movement at the local level and catastrophe at the larger level (hooking the leg bag or overnight hose on a door handle!).

 

CATH INSERTION:

 

The real advantage of xylocaine is for insertion of a cath through a troublesome stricture.  The same WARNING applies to use of any local anesthetic--it is possible to do great damage to the urethra without knowing it with xylocaine gel.  That said, using clean if not sterile field procedures, a patient or health team member can inject the 10cc of xylocaine gel into the urethra and the hydrostatic force opens and lubricates the channel prior to passing a catheter.  The entry point is then held or clamped off for a few minutes while the anesthetic does it's thing.  The catheter passes MUCH easier (slow and patient) than using Surgilube applied topically to the catheter surface and entry point.

 

Again, I have lots of experience that I don't remember signing up for.  I use the xylocaine infrequently, when the stricture is really shut down. I use a down-sized straight (Coudet curved tip for male) non-Foley cath for "clean intermittent catheterization" or CIC. (CIC would be inappropriate following surgical or other procedures as the urethra heals).  The caveat is that a larger size cath is more rigid and more likely to pass on occasion than a smaller cath.  I start large with a #18, if I meet impasse I do not force it but am patient.  If that doesn't work I go to the smaller #12 or #14. I even have a #10 but it can serpentine or even fold over as it meets the posterior stricture--not good.

 

As a medic I've run on many patients with bladder infections secondary to catheterization (primarily in-dwelling Foleys).  I was shocked to learn I would need one (the first time...  I've now had many).  I have been fortunate enough to have nurses, docs, or me take the time to keep a sterile or clean field.  I drink a TON of fluid to keep potential organisms from making a home in my waterworks and I insure that I empty any "residual"

urine from the bladder by catheter at least once a day--no pooling for bad actors.

 

For readers thinking, "why didn't he get a TURP to open that up?".  I had a laser TURP and in my case it made a bad situation worse--now I'm fearful of additional procedural damage that would leave me dysfunctional.

 

I drink cranberry juice knowing that it can irritate the bladder on some patients--it doesn't seem to bother my waterworks.  And--knock on wood--I haven't had an infection.  That surprises me with my history of transporting other Foley patients on an emergent basis.  (My experience is skewed as I only see 100% of the small percent who are in trouble.)

 

WARNING:

 

This is only my personal experience and NOT to be considered as medical training or prescriptive.  Any catheter patient should be carefully monitored and if they take on self-catheterization, it should be done with training by your doc or her/his staff.  I learned from a venerable uro-tech working at the University Med Ctr.

 

Hope this helps--I did a lot of Googling.  Also, sharing my experience on the web has had several patients offer help that I never would have received otherwise.  We all have little pieces of the overall PCa puzzle--I'm grateful to those who have shared themselves here.

 

Good luck with your "application",

 

Eric S.”

[pauldhodson]

Thanks for your comments I will read them all carefully When I Get a Moment. I ended up checking myself back into the hospital this morning after a hellish night I've been unable to self-catheterise without significant pain and bleeding. They have installed a indwelling catheter and suggested it should stay there for at least 2 weeks giving my traumatised tissues an opportunity to heal. Hopefully after that time I should be able to pee as well time will tell cheers Paul.

[alanbarlee]

Hi Paul,

Here's a link to a new Medivizor abstract that bears on your issue.
'Outcomes of palliative resections of the prostate in patients with locally advanced prostate cancer'
https://medivizor.com/public/view_article/15022787 
To learn more about Medivizor, visit https://medivizor.com/

I hope it's helpful.

Cheers,

Alan

[pauldhodson]

Thanks Alan.

[Charles (Chuck) Maack]

Keep us posted as to any relief finally determined without constant catheterization - we care!

[Colin Glover]

Concur here Paul.

[pauldhodson]

Thanks Guys, I appreciate the thoughts.