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Urology/hypotonic bladder, difficulties in ISC, symptoms of prostitis.

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Dear Doctor ,
   On previous  occasions I interacted with yu and benefited from your advice. I suffer from hypo tonic urinary bladder as a sequel to symptomless bladder out let obstruction complicated by enlarged prostate and brief period of antidipressent therapy (SSRI).Bladder was grossly distended with a maximum capacity of 650-700ml. As ISC became quite difficult TURP&BOO were performed  and is not successful as the obstruction resurfaced and i suffered from difficult catheterisation,recurrent infections, pain and symptoms of prostatitis.. Second surgery was performed (August13) after one year and this time the out let was found to be distorted, quite narrow, there was a false passage and soft Stricture at bulbar urethra which were corrected.  i am adhering to strict regimn of ISC with all precautions 5 times a day . so far no infections. but i face the following problems .

1) ISC is still a diffcult task especially from 3rd catheterisation of the day. Every time I need to pee a few ml then alone the splincter is relaxing enough to allow the catheter to pass.Deep breathing short cough are not helpful.
2) The above problum is  manageable to a greater extent by a tiemanns(coude tipped) catheter.But insertion of this catheter is not comfortable and i feel low grade irritation while the catheter is passed. Fearing traumatic changes and false passages i am not using this  on regular basis..
3) Pain and moderate burning sensationat prostatic bed area  few minutes after catheterisation   Use of coude tipped catheter  reducing this discomfort.
4) the worst problem is acute spasmodic pain and burning sensation 15-20minutes after ejaculation..iam sexually active but forced to restrict the activity once in a week or 10 days.
5) my urologist prescribed tryptomer 10mg BID to manage the symptoms of prostatitis . This dose is not helpful. Urine cultures are consistently negative .
6) My urologist is against using antibiotics on prophylactic basis.Previously i consumed good no of antibiotics which indued digestive disturbances and IBS.
I request you to advice me for the following quiries.
a) How best i can mange the symptoms of pain & burning esp after ejaculation
b) what may be the cause of difficulties in insertion of catheters and how to overcome them?
C)can I use coude tipped catheter on regulsr  basis (Iam using Nelton PVC catheters Fr12&14,  applying xylocain jelly and installing some gel into urethra before cathing)
I can void with abdominal pressure in sqatting position Is it advisable to adopt this practice under social conditions  which preclude cathing. Is that practice further damages the bladder.

d) my urologist advises to maintain a maximum out put of 1500ml /day , 300 ml at a time, which seems to be practically impossible. My mean out put over the past 25 days is 200, 400, 450, 350, 250 . I consume 1.5 lts of water.  Is this output leads  to over distension  and further damage the bladder muscles?
Is cathing in Public toilets which are highly unsanitary is advisable? Are there  chances of air born UTIs under such conditions?
Can use of Coude tipped catheters on regular basis advisable? are they harmful to urethral passage / prostate.

         thanking you
         Ramakrishna

Answer
Ramakrishna:

You've asked a number of questions which are really better addressed to your personal urologist.  Here are some guidelines:

There is something wrong if you are only voiding 200-450 ml per day.  Typically this only happens in severe kidney failure.

Normal bladder capacity is around 500 ml maximum.

There should not be a problem using coude tip catheters.  See if you can find a self-lubricating catheter as these often cause less irritation.

I'm not a big fan of xylocaine jelly because it can tend to burn initially and is a lousy lubricant.  Try mixing it 50/50 with surgical lubricant to make it more slippery.

Pain and burning after catheterization could be from prostatitis or local irritation.  Prelief and pyridium can help with the burning.  A different antibiotic might be helpful for the prostatitis.  Also try sitting in a hot tub twice a day as this sometimes help.

Cathing in a public toilet is less dangerous than not cathing when you need to.  Air born UTIs are not a problem and have never been reported.

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Stephen W. Leslie, MD

Expertise

Questions concerning erectile dysfunction, kidney stones and prostate disorders including prostate cancer. I have a special interest in kidney stone disease prevention.

Experience

Full time practicing urologist with 30 years experience. Associate Professor of Surgery and Chief of Urology at Creighton University Medical Center. Editor in Chief of eMedicine Urology internet textbook. Author of only NIH approved book written for patients by a urologist on the subject of kidney stones "The Kidney Stones Handbook". Inventor of the "Parachute" and "Escape" kidney stone baskets and the "Calculus" stone prevention analysis computer program.

Organizations
American Urological Association, Ohio State Medical Association, Sexual Medicine Society

Publications
Men's Health, Journal of Urology, Urology, Healthwatch Magazine, Emergency Medicine Monthly, eMedicine, "The Kidney Stones Handbook", and numerous articles in various newspapers. He is also the editor of the Urology Board Review by McGraw-Hill used by urologists to study for their Board Certification Examinations.

Education/Credentials
Graduate of New York Medical College with residencies completed at Metropolitan Hospital New York, Albany Medical Center and University of Wisconsin-Madison.

Awards and Honors
Thirlby Award of the American Urological Association. Rated as one the country's Best Urologists by the Independent Consumer's Research Institute

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