I apologize if this is the wrong forum, and I'd appreciate any pointers. This is a BPH AUR issue.
I would very much appreciate your consideration of the following:
I am 59. I have BPH, and have managed it for the past few decades without any medication. Unexpectedly, 2 months ago I had my first Acute Urinary Retention episode, which I think was triggered by some “ejaculatory stress”. A series of catheterization and 2 more AUR’s followed, one after the other. Twice now I have removed the catheter (at doctor’s direction) to see if I could urinate without it. Both times I failed, and had to be recath’d The third test is coming up soon.
I’ve been on Flomax/Tamsulosin and Finasteride for nearly 2 months now, My current catheter is 18 Fr Foley. I empty about 1500cc per day. But starting a few weeks ago I can also urinate, under control, OUTSIDE the catheter 25 to 50cc each time I feel the need to urinate. It’s not strong urge, but I do feel it. At those times all I do is sit down on the toilet and relax the (sphincter urethrae?) muscles, while not pushing at all, and 25 to 50 cc’s comes out into the toilet.
The Urologist thinks I’ll need surgery if this next removal doesn’t work. But this doesn’t make sense to me, as it seems the Flomax has increased the urethra passageway such that I “leak” outside the catheter.
The last time the catheter was removed, I started urinating while sitting. I was very glad to be able to do that. It started at 25, then 50, then up to 100cc. So the next time I felt the urge, I decided to stand to urinate rather than sit, and that’s when the problems started. There was a pinching feeling (both at sphincter urethrae and “levator ani” pubic floor muscle? “levator prostatae”?), and I could only get 50cc out. I sat down, and then got another 50. Thereafter it gradually got worse, until I couldn’t urinate at all, and then had to be recath’d. This was over the space of about 6 hours.
Why did this happen? Was there a muscle interaction, or did the prostate just resume it’s constricted geometry since the catheter was no longer forcing it open?
I’m wondering if there could be a spasm, or wrong electrical signals being sent that causes the passageways to constrict and muscles tighten up, even when there really is enough space through the prostate if everything was relaxed. Could there be a problem associated with the sphincter muscles and the pubic floor muscles?
I have not been able to find any information on this subject on the Internet and would greatly appreciate other experiences and knowledge sharing.
Thank you very much.