Bladder neck obstruction

Bri,

Just my experience, which may / may not be of interest. I was diagnosed with chronic urinary retention a couple of year ago.  At my maximum my bladder was retaining close on 2 litres.  This is no longer the case as I self catheterise, but it has left me with some kidney impairment and a floppy bladder (atonic?).

I had a Bladder Neck Incision (BNI) in 2013 - which didn't fix it then a TURP in 2014 which has improved things a bit but I still retain about 400 mls or more at the end of the day. The result is that I have to use an intermittent self catheter twice a day.  I have not had any UTIs so far (in one and a half years of using ISC) but I use sterile single use "no touch" catheters.

My understanding is that at the fill levels my bladder gets to now it is regarded as a low pressure bladder and so does not cause significant back pressure to my kidneys.  

It is the amount of urine retention that could potentially cause kidney issues after some time and 400 - 500 mls is full for a normal bladder.

So you really want to get your GP or Urologist to check your urine retention using an ultrasound scanner which they all seem to have now.

Martyn

Hi

Had another bladder neck stretch Monday 3rd Nov after getting down to a urine flow of 1.25 ml/ sec. Next step is a bladder neck incision if the latest stretch fails. Catheter fitted and to be removed Tuesday 11th Nov along with self catheterising instructions.

Wednesday morning woke with a swelling in the penis (thought the ED was cured) had the usual shower and clean but could not get the foreskin back over the end of the penis. By midday the swelling was worse and the foreskin was inflated like a balloon ( pictures available on request). Trying to get help from the district nurse took over 4 hours only to be told it was not her problem.

Our local hospital urology nurses came to the rescue, "get a bag of frozen peas on the penis until the swelling subsides, use a bit of lube and get the foreskin back over the end of the penis and keep using the frozen peas until the swelling goes down". Fortunately we had an ice pack so we still had veg with our dinner. Three or four hours later it was still tender but not swollen.

The surgeon still seems to think the stricture was caused by the way the catheter was removed, pulled out rather than slid out.

Thanks Chris

I have a picture in my head Chris, I can't get rid of it! Are you likely to be self catherising on a regular basis or is it just in case of urine retention? If you want any advice on ISC please send me a message, I do it at least three times a day and it's very routine now!

Thanks For the comments

Yorkhill

How long will I be self catheterising ? It is more for keeping the bladder neck open rather than urine retention, so it could be for some time.

Any insight and tips would be greatly appreciated, I have read a some of your posts on the subject but fore warned is fore armed.

This is the third time I have had a catheter in six months and not as comfortable this time.  When passing a motion get the feeling it is going to by pass but instead the penis swells, catheter is passing okay so not blocked , any ideas ?

Saw my ED guy yesterday he said the swelling was a good sign but keep off the pump until the stricture has been sorted. 

Thanks Chris

Carlos, it sounds to me like you need to try a different brand of pad, a stronger version of what you already have or should perhaps try the pants rather than the pads. You shouldn't be leaking onto clothing. What about Conveen sheaths?

Carlos

On my second bladder neck stretch, if you look back a few posts you will see I have had some issues. I found coping with the catheter a lot easier after the dilation than after the original op, you are a lot more mobile etc. Just watch out for the constipation after the op, I went straight for the laxatives second time. On the first dilatation the surgeon wanted the catheter out after 48 hours but due to resources it was about 7 days, will be 8days this time. Hopefully you should have a camera in there and the surgeon can have a good look round. They did find one of the hem o lok clips had migrated into my bladder possibly through the joint, it is rare 1 in 500 or so ,but well documented. if you search conversations for "bladder neck" you will find another guy who had a few dilatations before it was sorted. If this stretch does not work the surgeon  wants to cut into the scar tissue but this increases the risk of incontinence. Were there any issues when your catheters were removed, the surgeon suspects this could have damaged the joint. Hope all goes well.

Thanks Chris

Yorkhull

Thanks for the information.

11/11/14

Following bladder neck stretch I Had the catheter out on Tuesday 11th and did the obligatory few samples all without any issues. The nurse gave me instructions on intermittent self catheterisation. I had been told to do ISC twice a day but the surgeon had not left written instructions on how frequent or how long for, a follow up call came back with 3 times a week. Wednesday did my first solo ISC without any problems, as Paul says it sounds worse than it is. Continence still in tact, frequency and urgency getting better early morning visit 300ml in 15secs.

Once again a big thank you to Yorkhull (Paul) for all you info and help.

Chris

Edited by member 13 Nov 2014 at 22:04  | Reason: Not specified