My 92 year old father has been fitted with catheter for prostrate problem.As he is too old and a dementia patient in last stage TURP and other Surgical Procedures were not considered.Although Catheter is replaced at regular intervals,it is seen that urine quantity is now coming down resulting in bloating of abdomen.Possibly urine is not coming out due to some problems.What remedial step can be taken.Please help with your answer
Kalyan, if the urine output is markedly decreased, it suggests that either his kidneys are not producing enough urine or the catheter is partially blocked. As you have noted "bloating of the abdomen", I suspect there is catheter blockage. This can easily be determined by having the nurse irrigate the catheter with sterile water or saline. If they cannot get it open by catheter irrigation, the catheter should be replaced. If this is a recurrent problem, I suggest having a daily catheter irrigation with a solution such as dilute acetic acid to try and keep urinary salts from clogging the lumen of the catheter. Your father should also be encouraged to drink a fair amount of fluids to keep the urine more dilute. This will also help keep the urinary salts in solution rather than them precipitating out and blocking the catheter.
If he continues to have difficulty, an excellent option is the conversion of the penile catheter to a suprapubic tube. This can be inserted under local anesthesia by punching a small hole into the bladder through the midline of the lower abdomen. The advantages are many. The tube is much more comfortable because it not only bypasses the penis but the balloon does not rest on the bladder floor so it is less likely to trigger spasms. Also, a much larger catheter can be used if necessary. The catheter can be easily changed with a minimum of discomfort.
If, however, the catheter is not blocked, this would suggest that his kidneys are not making adequate urine. Evaluating this would entail a blood urea nitrogen and creatine (to see if waste products are accumulating in his blood) and at least an ultrasound of his kidneys. Good luck.