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Question
Greetings,

I have a theory and a question that I would like to discuss for publicís benefit. When I went to hospital ER 55 days ago and they put a foley catheter in my bladder and drained 1.8-L extra urine that was trapped there, on that day in fact I was able to extract 400cc on my own. On that day as I found out from CT scan, my bladder wall was 4-cm thick but still was able to extract 400cc at a time. After putting a foley catheter in for a long time and since my muscular bladder did not have to work at all for that many days, it became retarded even though my bladder wall is now less than 2-cm. I believe 55 days ago when my bladder could still push out 400cc, they should have showed me how to do self catheter (instead of foley catheter) to drain out only the excess urine. That way today I could easily void 400cc or perhaps more on my own then self catheter only for any trapped volume. By doing that, today instead of having a retarded bladder that is not able to extract at all I would have a bladder doing 70-80% of the job and able to recover with time. Am I right? If not, why not?
BTW, I am male and 60 year old.

Best Regards,
Ivan.

Answer
Ivan:

You are not right.  The fact that you can squeeze out 400 mL from an overdistended and overstretched bladder only leads to further bladder damage.  The best way to allow a damaged and stretched bladder to recover is to put it at complete rest with a foley and see if the bladder capacity and muscle tone recovers sufficiently to allow a possible surgical option such as prostate surgery.  If the bladder doesn't recover, then intermittent catheterization is a viable option regardless of your voiding on your own a little.

You werent' actually voiding the 400 mL; this was what we call "overflow" and it is a symptom of urinary retention and bladder overstretching.  Essentially, you were forcing it out in an abnormal fashion.  The normal bladder maximum capacity is 500 cc and you had 1800.  When you stretch out the bladder muscle to almost 4 times the normal size, most urologists would recommend a Foley to maximize bladder rehabilitation and recovery.  Good luck.

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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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