Post-Surgery Urinary Issues in Benign Prostatic Hyperplasia: Causes and Solutions

Postoperative urinary obstruction after benign prostatic hyperplasia surgery and medication management?

Dear Dr.
Hsu,
I hope this message finds you well.
My father is 84 years old and underwent surgery for benign prostatic hyperplasia (BPH) about 5.5 months ago, during which the doctor mentioned that 7-8 grams of tissue were removed.
He has attempted to have his urinary catheter removed, but he is still unable to urinate independently.
The attending physician indicated that his bladder has not yet recovered and has prescribed him 25 mg of Tamsulosin (Harnal) to take once in the morning and once at night.

I have the following questions:
1.
What could be the possible reasons for my father's ongoing urinary difficulties after surgery?
2.
Does long-term catheterization combined with Tamsulosin help with bladder recovery or independent urination? Is it necessary for him to continue taking this medication? He has been on it for several months without noticeable improvement and is eager to stop.
3.
What is the standard follow-up treatment for patients after BPH surgery?
4.
Is urodynamic testing the only method to assess the ability to urinate independently after surgery?
5.
What measures can be taken to improve urinary difficulties?
Thank you for your attention to these questions, and I wish you good health.

Mr. Lin, 80~89 year old female. Ask Date: 2021/09/28

Dr. Xu Wencang reply Urology

Further evaluation of the cause of urinary retention may require urodynamic studies.
Cystoscopy should be performed to rule out the possibility of urethral stricture and bladder spasms.
If bladder dysfunction is identified, consideration should be given to the patient's overall condition, and options such as bladder diversion or clean intermittent catheterization training may be explored.

Reply Date: 2021/09/28

More Info

Post-surgery urinary issues, particularly following surgery for benign prostatic hyperplasia (BPH), can be complex and multifactorial. In your father's case, where he is 84 years old and has undergone surgery 5.5 months ago, there are several potential reasons for his ongoing urinary difficulties.

1. Possible Causes of Post-Surgery Urinary Issues: After surgery for BPH, patients may experience urinary retention or difficulty in urination due to several factors. These can include:
- Bladder Dysfunction: The bladder may take time to regain its normal function after surgery. Surgical trauma can lead to temporary or, in some cases, prolonged bladder dysfunction.

- Nerve Damage: The surgical procedure may inadvertently affect the nerves that control bladder function, leading to issues with bladder contraction and sensation.

- Scar Tissue Formation: Post-operative scarring can lead to urethral stricture, which can impede urine flow.

- Infection or Inflammation: Post-surgical infections or inflammation can also contribute to urinary retention.

2. Impact of Long-term Catheterization and Medication: The use of a urinary catheter for an extended period can lead to complications such as urinary tract infections (UTIs) and bladder atony (loss of bladder tone). The medication you mentioned, likely an alpha-blocker (like Tamsulosin), is intended to help relax the muscles in the prostate and bladder neck, facilitating easier urination. However, if there has been no improvement after several months, it may be worth discussing with the physician whether to continue this medication or explore alternative treatments.

3. Follow-up and Monitoring Post-Surgery: Regular follow-up appointments are crucial for monitoring recovery after BPH surgery. This typically includes:
- Symptom Assessment: Regularly evaluating urinary symptoms and quality of life.

- Urodynamic Studies: These tests assess how well the bladder and urethra are functioning. They can help determine if there is an obstruction or if the bladder is not contracting effectively.

- Ultrasound: To check for post-void residual urine, which indicates how much urine remains in the bladder after urination.

4. Assessing Urinary Function: Urodynamic studies are indeed one of the primary methods to evaluate bladder function post-surgery. However, other diagnostic tools, such as bladder ultrasound and cystoscopy, may also be employed to assess for structural issues or complications like strictures.

5. Improving Urinary Difficulties: To enhance urinary function, several strategies can be considered:
- Bladder Training: This involves scheduled voiding to help retrain the bladder.

- Pelvic Floor Exercises: Strengthening the pelvic floor muscles can improve bladder control.

- Medications: If current medications are ineffective, alternatives or adjunct therapies may be explored.

- Surgical Interventions: In cases of significant obstruction or bladder dysfunction, further surgical options may be necessary to alleviate symptoms.

In conclusion, it is essential to maintain open communication with your father's healthcare provider to address these ongoing issues. A comprehensive evaluation, including potential urodynamic studies and discussions about medication efficacy, will be critical in determining the best course of action for improving his urinary function.

Similar Q&A

Understanding Urinary Retention After Laparoscopic Gallbladder Surgery

I just had laparoscopic cholecystectomy two days ago. I can urinate on my own, but I have no urge to urinate. What should I do to improve this? Is it caused by general anesthesia? Thank you.

Dr. Zhou Xinpei reply Urology
Hello: Some patients with benign prostatic hyperplasia may experience urinary difficulties after undergoing general anesthesia. Below are common symptoms of patients with benign prostatic hyperplasia for your reference. It is recommended that if you experience any of the followin...

Post-Transurethral Resection of Prostate: Understanding Urination Issues After Surgery

Hello, due to benign prostatic hyperplasia, I underwent transurethral resection of the prostate (TURP) a month and a half ago. Postoperatively, my urination was normal, but recently I have been experiencing more difficulty urinating and need to exert more effort (with a fluid int...

Dr. Liu Jiaju reply Urology
Mr. Chen: After undergoing transurethral resection of the prostate (TURP), it is common to experience temporary urinary difficulties or pain. Possible causes include infection, blood clots causing obstruction, or incomplete healing of the surgical site. It is recommended to incre...

Blood in Urine After Prostate Surgery: Symptoms and Treatment Options

Hello Doctor: It has been 3 weeks since I underwent surgery for benign prostatic hyperplasia, and I am still experiencing the following symptoms: 1. Blood in urine. 2. Frequent urination, needing to urinate again within 5 minutes after finishing. 3. Inability to control urination...

Dr. Liu Jianting reply Urology
Don't worry! These symptoms are common phenomena that can occur within two months after surgery. It is recommended that you return to the hospital for regular check-ups (every week).

Struggling with Urination After Surgery: Causes and Solutions

Due to recent orthopedic surgery, I am now experiencing difficulty urinating, requiring significant effort and time to complete the process. Both urine and blood tests have returned normal results, and there is no urinary retention in the bladder. The doctor indicated that this m...

Dr. Lai Ronghao reply Urology
Hello Sen: Your issue may be due to benign prostatic hyperplasia, weak bladder contractions, or even urethral injury, among other possibilities. Medication should help improve your condition. Please follow up at the urology outpatient clinic. Sincerely, Dr. Lai Rong-Hao, Attendin...