Patient's Query
Hello doctor,
I went into total urinary retention on March 14. I attended an ER, and a Foley's catheter was fitted, and I was advised that I had a slightly enlarged prostate (BPH). A week later, I was prescribed Tamsulosin 400 mcg. On March 26, the catheter was removed, but I went into retention again on March 30, and a new catheter was fitted in the ER. Due to COVID-19, all tests have been canceled for over two months. I now have a flip valve on the end of the catheter (no bag needed). About two days out of seven, I get blood in my urine. I am concerned about the cause. When I open the tap on the catheter, I feel that, as the bladder empties, it presses upon the tip of the catheter, which projects 40 mm into the bladder. Could the tip of the catheter be grating against the bladder wall, causing the bleeding? Is this a known problem? Is it possible to get a catheter that projects less into the bladder? The bore size of the catheter is 16, and the brand is Folysil Porges.
I planned to ask a doctor to remove the catheter for trial. Should I take an antibiotic at that time as a precaution? A urine test has indicated some minor bacteria, but I was advised that this did not need treatment. If I go back into retention, I want to avoid a catheter that possibly injures my bladder. I am hoping that my diet change, herbal remedies, plus Tamsulosin, may allow me to normalize until proper tests are available. Also, could a virus infection aggravate moderate BPH to cause a blockage? PSA was 6.0 and done after the digital exam and while the catheter was in place. No signs of cancer.
Kindly guide.
Hi,
Welcome to icliniq.com.
Coming to your query, I will answer your questions step by step. For your doubt, could the tip of the catheter be grating against the bladder wall and causing bleeding? Yes, but the chances are minute, and the amount of blood is also less. You can say sometimes clots can appear occasionally, but significant amounts like urine coming in a bag mixed with blood (red urine) is quite rare. It is a known but uncommon problem. There are small tip catheters available, but the indication to use them is not to avoid hematuria; rather, they are used to decrease irritative symptoms of the catheter. No antibiotic is necessary after removal of the catheter, but you should not discontinue Tamsulosin. Rather, I will suggest you have an antibiotic course of five days right now as it will cover UTI (urinary tract infection) as one of the causes for hematuria. A virus infection will not aggravate moderate BPH to cause a blockage. Though the PSA was 6.0, it still suggests that you repeat it after 3 months once you are off the catheter.
I want to ask you some questions. Are you a diabetic or hypertensive? How many days before you went into retention, urinary symptoms like poor flow, nocturia (getting up more than once at night for passing urine), urgency, frequency, and dribbling were present? Any history of surgery/catheterization for different reasons in the past? Any other medication you are taking chronically? Any history of hematuria in the past? Do you pass clots also anytime? Any relevant reports (ultrasound, urine culture, CBC, and RFT) you want to attach.
Please do reply.
Patient's Query
Thank you doctor,
I am not diabetic or hypertensive. I had not been aware of urinary symptoms until retention happened. In hindsight, I would have had to urinate more often than 10 years earlier, but this did not appear excessive. Maybe every 2 to 3 hours, whereas this would have been the same to four hours 10 years earlier. I did not have to get up at night. I noticed that I was less comfortable holding out, but this was not a problem. Flow rate seemed normal, but it would often take me up to 15 to 20 seconds to commence flow, whereas this was probably just 5 seconds when I was younger. I did not have any dribbling.
I never had a catheterization in the past. I had my appendix removed when I was 2 years old. No other surgery or medications. I never had blood in my urine until a catheter was fitted. And I never had any clots passed, until March 14th. Also, on March 26, when trial removal of the catheter was undertaken, the nurse advised me to urinate into a bucket: I have a photo of that showing the blood clots discharged, in the seven hours after the catheter was removed. In this period, after removal of the catheter, the flow rate was noticeably poor, in a way I had never before suffered, intermittently reducing to a tiny spray. I do not have any reports to share. I had an ultrasound scan done on March 31, when I went into retention the second time, and this indicated a volume of 1250 ml in my bladder. I enclosed the photo of the clots in urine.
Hi,
Welcome back to icliniq.com.
Drink a lot of water (so that your urine output over 24 hours is at least 0.5 gallons. You can take the tablet Nitrofurantoin 50 mg HS. Continue until you have a catheter in situ. Start syrup Citra alka 10 ml TDS (it's a urine alkalinizer to decrease urine acidity, if you have acidity, then you can reduce the dose to 5 ml, you have to take it mixed in water, not directly). You have to continue tablet Tamsulosin 0.4 mg HS as before. If you have not had any urinary complaints before this episode, then there is a high chance that this time, the catheter-free trial will be successful. In case of failed trial two options are there; uro dynamics study of the bladder, and cystoscopy examination. About a short tip catheter, it is a 30 cc Lubricath Foley two-way catheter. This model reduces the potential irritation caused by the catheter tip by rubbing the roof of the bladder. A shorter tip causes less tenting of the bladder roof.
I hope this helps.
Thank you.
Patient's Query
Thank you doctor,
I had the catheter removed on 1st May. This worked out, and I have been operating relatively normally since then. On 27th May, I received the test results for the recent urine test and the PSA test. PSA level had increased to 11.9, and the urine test indicated an infection of Enterococcus faecalis. My GP prescribed Amoxicillin 500 mg thrice daily, which I took for three weeks. This was followed by two weeks of Moxifloxacin. (five weeks in total). A new PSA test on 1st July showed that the level had dropped to 3.9, and the urine test was negative. I had made steady progress regarding flow rate, with an average flow of 8ml/min in the morning, to about 14ml/min in the afternoon. I stopped all medication in mid-June. I had an MRI scan of the prostate yesterday, as I wanted to assess prostate size and to eliminate the possibility of an abscess. I will try to upload the scan. I am concerned with four white spheres, one in the prostate, and three near the seminal vesicle. I understand that the scan shows that my prostate is enlarged. Perhaps you can indicate by how much? But, my main concern is that does it have an abscess?
Hello,
Welcome back to icliniq.com.
It is good to know that you are doing well. I went through your query and attachment (attachment removed to protect patient identity). According to my knowledge, that white spot can be some calcification or residual infection. The size of which does not seem to be much. I do not think anything else is needed at the moment unless you have any kind of symptoms.
I hope this helps.
Thank you.
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