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Urology/hypotonic bladder , painful catheterisation


dear doctor,
I am a male  patient of hypotonic urinary bladder developed due to symptomless, neglected long term bladder outlet obstruction and prostate enlargement and two hopful surgeries are of no use and i am on CISC 5-6 times a day.
  My splinter relaxes for catheterisation only when i pass few drops of urine other wise i should struggle for insertion. Further CISC  is always painful for me esp. while removing the catheter.  Detailed examination including cytoscopy, antibiotics are of no use. The neck of bladder throws in to painful spasms once the catheter was inserted till its removal and pain is more intense before the onset of infection and whenever i cath outsidethe home  making it very difficult to come in terms with life. Previously i experienced infection one/3months but when i shifted to catheters with polished, smooth eyelets they reduced to once in 6months . Cipro is the standard drug. urologist prescribed Detoropan 0.25 mg BID and this reduced the spasms but i am unable to relax the splinter by passing some urine as the contractions are virtually stopped.As a result iam struggling to insert the catheter. iam also prescribed to use tryptomer 10mg TID when i complained pain after ejaculation which is also not helpful. .
 Are previous surgeries  damaged the passage so that passing and retrieving the catheter are stinging? please advise me to mitigate the painful catheterisation and recurrent infections.



There is no evidence of any damage from the prior surgeries.  If there was some, it would have been visible at the time of the cystoscopy.  Use of a smaller catheter, possibly one that is pre-lubricated, might help.  If this is not adequate, another approach is to adjust the fluid intake so that the ICP can be done a little less often.  The goal is to get each catheterization to about 450 mL each.  If this is done 4 times a day, it would create 1800 mL which is more than the usual urine output for most normal people.  Another possibility is prostatitis which could explain some of the spasms and sensitivity.

If this is not successful, you may need to consider a suprapubic tube.  Talk to your local urologists about this possibility.


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Stephen W. Leslie, MD


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


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.

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

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.

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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