Urology treats urinary tract diseases in all genders and male reproductive issues, covering the kidneys, bladder, prostate, urethra, from infections to complex cancers.
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For Acute Urinary Retention, the immediate goal is to relieve pain and prevent bladder rupture.
Once the bladder is drained, medications are started to improve voiding mechanics, aiming for a “Trial Without Catheter” (TWOC).
If medication fails or the retention is recurrent, surgery is the definitive treatment to remove the blockage.
1. Transurethral Resection of the Prostate (TURP) The “Gold Standard” for decades. An electrified loop is used to shave away the inner core of the prostate tissue piece by piece, coring out the channel like an apple. It is highly effective but carries risks of bleeding, electrolyte imbalance (TUR syndrome), and retrograde ejaculation.
2. Holmium Laser Enucleation of the Prostate (HoLEP) A state-of-the-art technique performed at Liv Hospital. A high-power Holmium laser acts like a “tactical knife” to separate the entire prostate adenoma from its capsule. The tissue is pushed into the bladder and removed with a morcellator.
3. Minimally Invasive Therapies (MISTs)
4. Prostatic Artery Embolization (PAE) An interventional radiology procedure where the blood supply to the prostate is blocked via the femoral artery, causing the gland to shrink. Suitable for patients who cannot undergo anesthesia.
5. Urethrotomy / Urethroplasty For Urethral Strictures. A laser or knife cuts the scar tissue (Urethrotomy), or the scarred segment is surgically removed and reconstructed using a graft from the mouth lining (Buccal Mucosa Graft Urethroplasty).
If the bladder muscle is dead (myogenic failure) or disconnected (neurogenic), opening the outlet won’t help. The pump is broken.
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After you have a catheter placed for retention, we usually start you on medication (Alpha-blockers) for 3-7 days to relax the prostate. Then, you come to the clinic, we remove the catheter early in the morning, and observe you for several hours to see if you can pee on your own. We measure the residual urine. Suppose you can empty efficiently, great. If not, the catheter is replaced, and we discuss surgery options.
Insertion can be uncomfortable, but once it is in, it should not be painful. You may feel a sensation of “needing to pee” because the balloon is stimulating the bladder base, but this usually subsides. If you have sharp pain, the catheter may be blocked, in the wrong position, or causing bladder spasms.
If the cause is obstruction (like a large prostate), surgery (TURP/HoLEP) has a very high cure rate (>90%). If the cause is a weak bladder muscle (acontractile), surgery to open the prostate might help gravity drainage, but it won’t restore the muscle power. Urodynamics helps predict this success rate before surgery.
The most common side effects are dizziness (due to lower blood pressure, orthostatic hypotension), stuffy nose, and “Retrograde Ejaculation” (where semen goes backward into the bladder during climax, resulting in a dry orgasm). This is not dangerous but can be bothersome for some men.
It sounds daunting, but it is a simple, clean technique that thousands of people do daily. Liv Hospital nurses provide hands-on training. It takes about 2 minutes to do, gives you complete freedom (no bag attached to your leg), and protects your kidneys better than any other method.
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