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Acute Urinary Retention

User
Posted 26 Nov 2022 at 18:00

An increasing PSA has resulted in my return to the Prostate Cancer Diagnostic process, no cancer having been found when I first underwent a Transperineal Biopsy in June 2020.

I have had a recent MRI followed by a further Transperineal Biopsy, under general anaesthetic on Thursday 24 November. The hospital is 16 miles from my home. I have been told that I should receive the results of this biopsy in six to eight weeks. I went to theatre at 1700 & was allowed to leave the hospital at 2030, without problem. Some four hours later I was suffering with Acute Urinary Retention. The hospital where I had my biopsy offer only a Minor Injuries Unit at night & were, I am told, not resourced to deal with any problems arising from the insertion of a catheter. I was referred to the Accident & Emergency Unit at a neighbouring hospital who considered that it was a urological issue that should be dealt with by the hospital where I had the biopsy.

I am unsure whether Acute Urinary Retention is a 999 issue &, in any case, ambulance availability was an issue. I then went through the 111 'loop' finally speaking to a doctor at 0500 who advised that I should immediately go to the A & E Unit & forewarned them of my arrival. Fortunately our daughter had travelled 120 miles to be with us & was able to drive the, say, 18 miles to A & E. Another long wait before a triage nurse attempted to insert a 'standard' catheter which immediately blocked - followed by perhaps an hour spent in agony & thinking that I had been forgotten whilst the change of shift was seemingly completed after which a doctor inserted a '3 way catheter' which solved the problem.

What did I do wrong or could I have done better ? 

 

User
Posted 28 Nov 2022 at 18:20

Thanks again Chris - Your replies are really helpful & reassuring.

I am now fitted with a two way catheter - the collar is red - I think that the consultant who fitted it yesterday said it was either a 16 or a 16.5.

I managed to get hold of a raised toilet seat today which helps matter - unfortunately I could only get hold of a 4" 'raise', I think 6" would have been be better. I have just had slight bleeding around the catheter when passing a motion - I suppose my greatest fear is that the whole thing will 'fall out' ! I experience greatest discomfort when I am sitting a position where the catheter can't easily drain - my knees being bent so that the connection to the bag is 'uphill' from the catheter itself. It is just something that I am going to have to get used to - hopefully I will be catheter free in a couple of weeks

User
Posted 29 Nov 2022 at 08:40

Chris - Thanks again ! My day bag is on my knee - we stand my night bag, which is supported by a plastic bracket, in a bucket - the hose is quite long & has not interfered with my sleeping. I was surprised that I almost filled the night bag last night - at least I am not passing much blood now !

I am still getting some blood around the outside of the catheter when I try & sit on the toilet - I bought a raised seat (4") yesterday but think that I could probably have done with a 6". This morning I tried a 'squatting position" ! I am trying using a gel to ease the soreness around the entry point of the catheter. I will get there in the end - but I will be glad when the catheter is removed. I am probably being stupid but this is my second biopsy & I hope that they find something this time.

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User
Posted 26 Nov 2022 at 18:43

Grafton, I don't think you have done anything wrong. retention is classed as a medical emergency and given your age , previous treatment and situation, I would have thought the ambulance was appropriate. 

With it being a three way catheter is somebody going to be flushing is it for you or it that the only thing they had ? Have you been given any flushing bottles, you probably won't need any but our DNs say they don't carry them

Just in case of further issues do you have details of the out of hours district nurse. 

If you feel confident and the hospital will train you , you ask for some self catheterization equipment.

Keep drinking plenty. 

Thanks Chris 

Edited by member 26 Nov 2022 at 18:44  | Reason: Not specified

User
Posted 26 Nov 2022 at 19:20

Chris

Thanks for you reply - at present my wife & I feel extremely vulnerable & unsure of the steps that we should take in the event of a recurrence.

My 'system' was flushed but I was not told that I should continue with 'flushing' & no such equipment was supplied. I was given a basic supply of catheter bags together with a number to call to obtain further supplies - which my wife has arranged. No advice was given as to support other than that the Urology department at the hospital who completed the biopsy would be in touch to arrange for the catheter to be removed at an appropriate time. I intend to speak to our GP practice on Monday to see what support they can provide.

We don't live in the 'sticks' so to speak but are some distance from the main hospitals in the area. The system may function 9 - 5 on weekdays but there doesn't seem to be much there out of hours. I don't have confidence as to the steps that I should take in the event of another medical emergency - I am perhaps of a generation that sees 999 being our lifeline but the resources no longer seem to be there.

User
Posted 26 Nov 2022 at 19:38

Grafton, just too give you some assurance in over six years of having a catheter I have never gone into retention with a catheter in. I have had temporary blockages. Make sure the pipe doesn't get kinked or bent and keep hydrated. If the eye of the penis gets sore buy some instilagel or hydrocaine from a pharmacy, boots tend not to sell it without a prescription, most others do,it is only a couple of pounds. Snug but night underwear will help keep the catheter from moving and rubbing in the penis. 

I strap the night bag tube to my ankle at night with a spare strap, it just save pulling on the joints if you are a restless sleeper. Make sure the joints are tight, in my experience nurses don't push in properly.

Thanks Chris 

User
Posted 27 Nov 2022 at 17:53
Another day& another visit to A & E !

I started to 'bypass' intermittently this morning - primarily when I was standing. A 16 mile drive to hospital - triage - a specialist nurse who 'deflated' the balloon that helps keep the catheter in position, adjusted its position & re-inflated, giving my 'system a good flush ! A & E Consultant, Urological Consultant - all seemed OK - back to the carpark only to bypass again ! Back to the Urological Consultant - replacement, slightly smaller & less cumbersome catheter - home again !

Next problem - lower myself to 'sit' on the toilet which seemingly compresses or twists the catheter - considerable discomfort & a small leakage of blood around the outside of the catheter. I have no experience of these things & maybe I just have to get on 'with it' - should I just have to 'slightly squat' & 'do my business' into a plastic container or something ? Or is something wrong ?

User
Posted 27 Nov 2022 at 19:02

Grafton, I was told by my district nurses that once a balloon is deflated the catheter should be changed. 

I bypassed a small amount of blood and urine probably with every urethral catheter I had. With my suprapubic catheter I usually bypass a small amount and usually when passing a motion. I sometimes bypass more through the penis than the bag when I have a urine infection, with  a suprapubic catheter it is easier for urine to come out of the penis. 

I assume you now have a two way catheter, what colour is the little collar, most guys seem to be fitted with a size 16. I have never had to use a different position when passing a motion but as said bypassing when passing a motion is frequently mentioned.

I frequently used a bit of instilagel down the eye of the penis, it helped the penis move over the catheter rather than pull on the catheter.

If the catheter is slightly in the wrong position bypassing will be worse. 

Thanks Chris 

 

User
Posted 28 Nov 2022 at 18:20

Thanks again Chris - Your replies are really helpful & reassuring.

I am now fitted with a two way catheter - the collar is red - I think that the consultant who fitted it yesterday said it was either a 16 or a 16.5.

I managed to get hold of a raised toilet seat today which helps matter - unfortunately I could only get hold of a 4" 'raise', I think 6" would have been be better. I have just had slight bleeding around the catheter when passing a motion - I suppose my greatest fear is that the whole thing will 'fall out' ! I experience greatest discomfort when I am sitting a position where the catheter can't easily drain - my knees being bent so that the connection to the bag is 'uphill' from the catheter itself. It is just something that I am going to have to get used to - hopefully I will be catheter free in a couple of weeks

User
Posted 28 Nov 2022 at 20:14

Grafton , orange is a 16, although some orange collars do look more like red. Red is an 18, and you don't want any bigger than that. The balloon when filled with 10 ml of fluid is about an inch across, from experience it would take some doing to pull it. My balloon normally deflated over time and even with only 4 ml of fluid it never came out. 

Assuming you bladder is still working, the bladder pressure will still push the urine out. 

Where is you leg bag  thigh ,Knee or calf and how long is the leg bag tube. Hospitals tend to give you what they have not what is best.

Thanks Chris 

User
Posted 29 Nov 2022 at 08:40

Chris - Thanks again ! My day bag is on my knee - we stand my night bag, which is supported by a plastic bracket, in a bucket - the hose is quite long & has not interfered with my sleeping. I was surprised that I almost filled the night bag last night - at least I am not passing much blood now !

I am still getting some blood around the outside of the catheter when I try & sit on the toilet - I bought a raised seat (4") yesterday but think that I could probably have done with a 6". This morning I tried a 'squatting position" ! I am trying using a gel to ease the soreness around the entry point of the catheter. I will get there in the end - but I will be glad when the catheter is removed. I am probably being stupid but this is my second biopsy & I hope that they find something this time.

 
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