Question: Doctor, I was diagnosed with an Acute Prostate Blockage (virtually no urine could pass through my penis) in September of 2013. A catheter was installed then and I have replaced it with a replacement catheter each month since then (in other words, about 13 successive catheters). I am planning to seek a more permanent solution this week and I have some questions about this. However, a different situation occurred when the last catheter was installed (the one for January of this year). The catheter that was replaced fell out of my penis and remained out for about an hour-and-a-half (the time it took me to travel the eighty miles to the doctors office for a replacement) and a pain similar to the original pain back in Sept. of 03 occurred. This pain started about an hour after the catheter fell out. But then, to my surprise, urine started to come through my penis and soaked my pants. I was surprised because in the original diagnosis, no urine would pass. When I got to the doctor's office much to my surprise, urine once again was expelled through my penis as I sat on the toilet. I could increase its flow, just as I used to do before the injury, by tightening my muscles. Is it significant that this is the longest period of time that my penis was unimpeded? Why has the total blockage changed such as this? Does this indicate that the catheter caused a passage to occur through the prostate allowing the urine to pass? Does this indicate that surgery might work to correct the problem. Physically, I used to weigh 210 but now weigh 150. My prostate was regarded as large when I weighed 210 and is larger, of course, in proportion my smaller body. In fact, I have speculated that the blockage itself may have occured because of the weight loss which occured before the blockage. My waste has diminished by about eight inches and my stomach is much smaller necessitating frequent small meals. One other fact which may be appropo is that the catheters were painful until about the ninth one. It was impossible to sit and the only sitting I did was for driving while sitting on two large pillows. But the last couple of catheters have not been painful and the current one is practicallly painless, and virtually painless while driving. Does this mean that the catheters have created a passage, as I describe above, whereas in the beginning they were more intrusive (and abrasive). Does this occur often -- the diagnosis changes over time form no passage of urine to what I describe here? And finally, what is the process for replacing the catheter with a new system? Does it take practice closely supervised by doctors, nurses, etc. I have VA and they tend to rush patients through like cattle and pride themselves on "numbers seen" while claiming that the "patient comes first". The fact is that the "VA System" comes first and this facility sees five-hundred patients daily. It is difficult to get much attention and most appointments are over in 15 minutes. Doctors will not return your calls or talk to you without an appointment. I have to drive eighty-miles to get to the facility, only to be turned away due to a mistake in the appointment process. In one case, the doctor was in the next room, but I was forced to make an appointment, drive eighty miles to my home, then eighty miles back the next day to see the doctor who had been four inches away -- one wall -- two pieces of sheetrock, etc., away. (This is what they mean by the "patient comes first.") So, I am concerned about how I will be treated which is one of the reasons I haven't pushed this along sooner. Also, I appreciate your advise that I will be able to contemplate, respond to, etc. -- and seek a third opinion, etc. Yours truly, XXXX

I will wait until I get the doctors response.

Doctor XXXXXXX Thank you for the quick response -- I appreciate it. By Endo-neurologic procedure you mean to remove the entire prostate, or parts of it, etc. I don't drink and as far as I know I had only had one bladder infection thirty-years-ago. I think the biggest offender may have been the extensive sitting I did as a graphic designer -- often as long as twelve to fifteen hours per-day, and my extensive biking over many years which involved sitting on a less than ergonomic seat. Just prior to the blockage I had replaced the seat because I was noticing extensive pain in the area. I never dreamed that it would be the prostate and could cause me so much damage. Also, I don't take drugs, etc. Oh, and the catheter was a size twenty which was the largest they had. The VA physicians that examined me did not mention surgery as a possibility although I observed that those who were getting surgery seemed to be ex-officers and/or influential people. After a cursory examination without any xrays or ultrasound they told me that I would have to use a self-dellivered catheter four times daily. I thought their exam was cursory at best. What are the criteria they use to determine when an endo-neurologic procedure is appropriate. What inferences should they make regarding the flow representing a strengthened bladder. I had started to notice that a urine flow was coming around the catheters as well as within, and that I could push urine out despite the catheter. Could the fact of the catheter acting as an obstruction force the bladder to strengthen. I need to know what questions to ask the doctors -- Specific questions in medical terms because they are not accustomed to patients asking detailed questions. At least the doctors I talked to were not, and even if they had been willing to answer questions, I would not have known what to ask. So, can you give me a list of specific questions I should ask including the possible, or should I say, most probable answers to expect? As I stated in the first question they don't spend much time with patients -- an assembly process that lets us fall through the cracks. Finally, one doctor did mention the possibility of incontinence resulting and that this could be a result of a lack of bladder strength developing over this period. Finally, they are not accustomed to a patient using catheters for this length of time. Are there any adverse effects. Two months ago I was given a Oxybutinin to address a pain I was feeling which they said was a result of bladder spasms. Personally I thought the pain was the result of a poor installation of the catheter. Having experienced as many catheters as I have I can attest to the fact that some individuals are better than others at installing catheters. (One fact that I forgot to mention initially is that the emergency room physician who installed the first catheter said he drained out more than two pints of urine initially and that he had never seen that much urine in an individual without ramifications suc as kidney damage. I don't know if this is signficant or not.)