Urology/catherer

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Question
I don't urinate in big quantities.i don't know if intermittment catherer is removing all urine from bladder.i use intermittment catherer twice a day and about a quarter of cup of urine comes out.if you have 200 cc of urine in your  bladder are you prone to infection/many people cant empty their bladder.isnt it silly to catherize when only a quarter of cup of urine comes out.my kidneys are fine I had ultrasound

Answer
Frank, there are many conditions that may cause a male to have difficulty emptying the bladder.  Ones ability to urinate depends on 2 opposing factors: the force with which the bladder muscle contracts which has to work against the resistance in the urinary canal (urethra).  Anything which decreases the former or increases the latter make it more difficult to urinate and empty the bladder efficiently.  Normally, after urination the bladder should retain less than 30 cc (one ounce) of urine.  This is called the "residual urine".   Excessive residual urine (such as the 200 cc example you note) can predispose to urinary infections and  kidney damage from back pressure.  

Disorders that may increase the resistance in the male urethra include an enlarged prostate (the most common causes being benign enlargement or prostatitis), urethral strictures (narrowing), urethral valves, contractures of the bladder neck, etc.

In addition, chronic distention of the bladder muscle prevents it from contracting with maximum force which exacerbates the residual urine accumulation.   Contractile force can also be adversely affected by a number of medications including those used for anxiety, depression, pain (especially narcotics), antihistamines, GI disorders, & many other conditions.  Furthermore, putting  off the desire to void by holding your urine too long over-stretches the bladder muscle which then may not be able to contract forcefully enough to empty.  Many men with pre-existing urologic problems often go into urinary retention after surgery due to many of the factors mentioned in this paragraph including the effects of anesthetic agents.    Retention can also be precipitated by excessive alcohol as this is a central nervous system depressant.  Alcohol may also prevent one from being aware that the bladder is full before it is too late. Certain neurologic diseases, such as herniated discs, MS, Parkinsonism, etc. often adversely affect bladder emptying.  Lyme disease sometimes affects the central nervous system and occasionally causes urinary retention.

As there are so many conditions that can cause male voiding difficulty, one need to see a urologist in consultation .  A complete history, physical examination and some laboratory tests need to be done.  At the very least, measurement of your residual urine will be done.  Depending on the above, further testing such as a cystoscopy. urodynamic studies,  and imaging of the upper urinary tract may be indicated.  After a diagnosis is established, a proper plan of management can be recommended.  

In summary, it needs to be determined what your true residual urine is after voiding.  Your urologist can easily determine the by either catheterizing you after voiding or doing an ultrasound of the bladder after voiding.  If your quarter of a cup is the amount you get on catheterization is accurate (this is about 60 cc), you do not need to do self catheterization.  However, it would be much more accurate for a urologist to measure this for you.  When you do self catheterization, it is important to first let the urine flow out and THEN GRADUALLY withdraw the catheter a little bit at a time.  If you pass it too far into the bladder, when it stops draining and then you just pull it out, you may a significant amount of urine behind which defeats the whole purpose.  Good luck.

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Arthur Goldstein, M.D.

Expertise

Problems or questions related to the field of urology; ie urinary stone disease, urinary cancers (kidney, bladder, prostate, testis, etc.), urinary infections, etc. I no longer answer questions related to erection problems or male sexual dysfunction.

Experience

I am retired from the active practice of urology. My 34 years was totally in the clinical field and involved the entire gamut of genitourinary problems, with special interest in endourology.

Organizations
American Medical Association, American Urological Association, American College of Surgeons

Education/Credentials
College degree - BS Medical degree - MD Master of Science - MS

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