Q. I have difficulty in passing urine without catheter even after cystolitholapaxy. Why?

Answered by
Dr. Samer Sameer Juma Ali Altawil
and medically reviewed by Dr. Sushrutha Muralidharan
This is a premium question & answer published on Jul 07, 2021 and last reviewed on: Aug 11, 2021

Hi doctor,

On the thirtieth two months ago, I had a bladder stone removed by cystolitholapaxy. No catheter was put in, and that afternoon I could not urinate. I went back to the urologist, and a catheter was put in. On Monday, it was taken out, and after a few hours, I discovered I could not urinate. The catheter was put back in, and I was put on Flomax. The next day, the catheter was taken out, and again I discovered that I could not urinate. The following day, a catheter was put in, and I was put on steroids (a Medrol pack). Two days later, the catheter was taken out, and I was fine. I could urinate easily. For about a month, it was fine, though with burning after peeing. On the eighth of this month, I began to have difficulty peeing and saw my urologist. On the tenth, I could not pee at all, and a catheter was put in. I was put back on another dose of steroids and also Flomax. For several days, everything was perfect. I could pee easily and without pain. But then it became increasingly difficult to urinate. I was told to double the Flomax dose. On Sunday morning, I could not urinate at all and went to the emergency room. While waiting for a catheter, I was able to urinate. I was put back on another dose of steroids. I am still taking Flomax. I can urinate now, but with pain and with less than a usual urine stream. What is the problem? Kindly give your opinion.



Welcome to

You have an enlarged prostate gland which causes this difficulty in passing urine, and secondary bladder stones, which were treated. Bladder stone itself is an indication for transurethral resection of the prostate, which causes occlusion and difficulty passing urine.

Treatment with Flowmax (Tamsulosin) failed. And steroids have no role in treating an enlarged prostate. Therefore, prostate enlargement treatment is divided into two. One is a medical treatment for mild to moderate symptoms and surgical for severe and complicated cases like recurring retention and bladder stone formation or recurrent UTI (urinary tract infection). For assessment, you required an ultrasound KUB (kidney urinary bladder), urine culture, and serum PSA (prostate-specific antigen). After that, you will need cystoscopy and resection of the prostate, which can be done by bipolar diathermy, laser, or resume.

I hope this was helpful.

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