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Urinary Retention following RP

User
Posted 22 Jun 2017 at 09:26

Age 69

PSA 9.8

Gleason score 7 (3+4)

All 6 biopsies on LH side positive for cancer with slight capsular bulging

Perineural invasion present

 

Hi

My brother undertook RP on the 2nd June this year. Following the surgery the surgeon advised all had gone well from his perspective.

As is normal he was fitted with a catheter which was removed after 10 days. Following removal he drank around 1 1/2 l of water but was only able to pass around 100 ml. His bladder was scanned several times to show it had fluid in it. More concerning was that despite him having a full bladder he had no/little sensation of needing to pass urine. After some 15 hours  and with a lot more water in him they decide that he would have to be  catheterized again resulting in him having an unplanned stay in hospital overnight.

He was told to return 10 days later, yesterday, when they would try again.

On this occasion before removing the catheter they backfilled his bladder with around 400 ml of water. They then removed the catheter. Soon after this he passed around 200 ml. A following scan showed around 200 ml still retained in the bladder.

He was then asked to drink around 1 litre of water. This was around 11.30 am and by around 4.30 pm he had not passed any urine with a scan showing that his bladder had plenty of fluid in it. Again, very concerning was that he had no apparent bladder constriction or sensations that he wanted/needed to pass urine.

They said that they would give it another hour and after that they would have to catheterize him again which they have done and told him that this must now remain for a further 3 weeks, much to his dismay as it is very uncomfortable for him.

Following the first attempt it was indicated  that they would pass a cystoscopy up his urethra on the second attempt, yesterday, if he was unable to pass urine to see if there were any strictures or swelling.  However, when I asked them to do that they said it was too dangerous though they are happy to pass a catheter?

They don't seem to have any plan of action that they will undertake in 3 weeks time if he still has the same problem and my brother is deeply concerned that he is going to be left on a catheter for the rest of his life?

Prior to the surgery the surgeon advised that he would perform the  RP from behind or to the rear as this gave better outcomes with reducing incontinence? Is anybody familiar with this procedure or terminology?  

Is UR a common problem with RP? I thought the opposite was the case, incontinence?  At no stage prior to the surgery has anybody ever mentioned UR as being a problem or side effect only incontinence?

Is there anybody here who has experienced this problem who can advise what the problem might be or where one could get some advice as the hospital currently don't seem to have any answers or plan in place to understand/solve the problem?

Prior to the surgery my brother had problems passing urine.

Any advice or insight in this would be appreciated.

  

User
Posted 22 Jun 2017 at 15:53

Just bumping you Rudge in case somebody else can help
Was the operation done in this country?

We can't control the winds - but we can adjust our sails
User
Posted 22 Jun 2017 at 20:31

Thanks for the bump.

Yes it  was done in the UK, East Sussex area. 

User
Posted 23 Jun 2017 at 18:44

Hi Rudge

This must be a bit of a nightmare for your brother.

I have no direct personal experience of this as I had incontinence following RP but my brother had a problems with retention. He had his RP about 6 weeks before I did and he experienced pain and discomfort from the UR despite follow up visits to the hospital. It was only 2 months ago (roughly 2 years) after his op that it was discovered that there was a small flap of skin in the urethra that was still attached and was causing a partial blockage from time to time. This has now been removed and he is fine but just has to insert a disposable catheter each morning and then remove it again just to ensure that the tube doesn't close over. It would be like popping a post in an ear piercing every morning and then removing it straight away just to ensure that the hole doesn't grow over.

This might be nothing to do with what is causing your brother's problem as my brother had not lost any bladder sensation.

I am sorry that I cannot offer any further insight into what could be causing the problem but I sincerely hope that his team can resolve it soon for him.

Kind regards

Kevan

User
Posted 24 Jun 2017 at 00:38
Ridge

I can understand the reluctance not to do a cystoscopy so soon after the surgery. Strictures are not rare after RP but normally show up after a few weeks or months. As Kevan has said there could be an obstruction in the urethra, or it could be swelling or an infection.

Did bro have Radical perineal prostatectomy?

Thanks Chris

User
Posted 25 Jun 2017 at 10:47

Thanks for the replies.

It clearly is not the norm since few seem to have experienced it.

He has an appointment to have the catheter removed again on 12 July and it has been tentatively agreed that they will use a cystoscopy on this occasion if he is still unable to pass urine to see if there are any strictures or swelling around where the urethra has been joined to the bladder. But it is concerning that he seems to have lost the sensation that his bladder is full?

Looks like he will have to undertake urodynamic testing to establish if some of the automatic nerves have been damaged during the operation?

I sincerely hope not.

Edited by member 25 Jun 2017 at 10:48  | Reason: Not specified

 
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