19 - CATHETER (PART 3) - NURSE CATHY & THE UROFLOW TEST

My reunion with the catheter happened in 2021. I wish it had been much sooner. By now I was virtually unable to pass any liquid and my quality of life had plummeted. I was in permanent pain, exhausted and dealing with a constant urge to go to the toilet.

Night time was the worst. Going to bed held no attraction. I didn't sleep. 

I kept an empty Sainsbury cranberry juice carton beside the bed so that I didn't have to keep making the long trek to the loo. 

On a good night I only got up to try to pee 6 or 7 times. On a bad night (nearly every night was a bad night) it was over 15 times. On a very bad night it was over 20. My record on March 3rd 2021 was 26 times. By the end of that night there was less than half a cup of pee in the container and I was in despair.

In a 5 page pleading letter of desperation to my hospital's urology department in April 2018 I begged them to find a way to treat me, writing the following:

'Between the acute pain and the unending lack of sleep I am permanently exhausted. The result of this is that I feel physically and mentally broken. My sense of myself in the world has changed. My confidence is at rock bottom. I feel inadequate and extremely insecure. I don’t socialise in any form anymore. I frequently have to turn work down knowing I won’t be able to function properly. Running to the toilet every 10 minutes doesn’t look good to clients. In short - I am in crisis ...'

My plea fell on deaf ears. There was no reply. Little did I know then that I was over 600th on a National Health Service waiting list of men in the same desperation as me - and that was just in my small part of the world.

In May 2020 - 2 years and one month later I finally got an appointment for a uroflow test. This complex sounding test takes less than an hour most of which is spent by the patient waiting to pee in to a cup so that your flow rate can be estimated. It's that basic - no scans or prodding or being plugged up to a machine - just you, a big jug of water, and a pee pot and a toilet cubicle.

On arrival I was met by a very pleasant female nurse called Cathy. Softly spoken and very calm she talked me through what was going to happen. I'd drink as much water as I could, then wait until I needed to pee. When I had done that the urodynamics test would be complete and I could leave.

She handed me a two litre jug of water and I began drinking as instructed. Given that I was in a hospital urology department I assumed I was in safe hands and that the nurse knew what she was doing but drinking so much water was worrying to me. In the previous months and years I had worked hard at limiting my liquids intake. How I was going to get so much of the bloody stuff back out of me now!? It felt like I was walking voluntarily into an act of self-harm. 

With several large cups of water consumed I sat and waited. I'd felt the need to pee even before I'd arrived (the urge was constant) but as the water moved out of my stomach and down to my bladder** the urge grew steadily.

** little known fact - from the stomach water takes a very circuitous path to the bladder - small & large intestine - blood stream - liver - heart - blood stream again - cells - blood stream again - kidneys - bladder.

There was one other 'patient' in the large featureless room in a characterless building on the Lisburn road in Belfast. We acknowledged each other from a distance but didn't talk. What would there have been to say? - "So what are you in here for!?" "How are you feeling?" I paced the room to speed up my need to pee. Around 20 minutes after my water intake the familiar stinging pain kicked in and set my dick on fire. Nurse Cathy was nowhere to be seen. When she eventually appeared she ushered me in to a toilet cubicle with a disposable cup to pee into. Despite my urgency only half a finger of pee passed out my urethra. The pain and urgency remained.

Collecting the cup, Cathy went off and measured it. On her return she questioned me about how normal this small amount of flow was. "This is my normality!" I told her. She asked how often I'd get up to pee during the night. "It can be more than 20 times." I said, concerned that she wasn't going to believe this ridiculously high figure, but she didn't question me and I could see that she was showing genuine concern. After asking what medication I had been prescribed and how effective I thought it was she paused for a moment and then said "Have you ever tried self-catheterisation?" 

Whilst I knew from a previous encounter what catheterisation was I had no idea what the 'self' bit had to do with it. In my experience one had been pushed into me whilst I was unconscious and I had never even tried to work out how that had been done. It didn't bear thinking about at the time!

Nurse Cathy sat down beside me and quietly told me that she could see that I was in a lot of discomfort and that it might be worth me trying self-cathing. Still not understanding what the 'self' bit meant (my brain was shouting 'HOW DOES IT GET IN THERE FFS!?) I told her I'd try anything - ANYTHING AT ALL. It had taken me so long to get to this place - this medical environment -  that I really didn't want to leave without some sort of intervention. I had built myself up to an expectation of being treated - being helped - maybe even being cured right there and then! Now just having been told to piss into a pot was worrying me so self-cathing was at least better than being told to go away and wait for the next appointment.

"I don't know what it involves but I'll try anything. What do you need me to do?" Cathy went away and returned with a small package. She explained that I needed to insert a tube up my urethra and asked me if I wanted guidance. I had no choice. We walked into a cubicle and she tore open the packet revealing a blue wrinkled tube attached in a circle. I unzipped, pulled out my penis and presented it to her with some degree of embarrassment. She unscrewed the join in the tube and it fell straight. It was a foot long! She asked if I wanted her to do the insertion for me or if I wanted to do it myself. At that moment I couldn't entertain the idea of performing this simple but very strange operation myself so I asked her to start it for me. "Can you lift the tip of your penis up towards me please?" she asked pulling the sterilised catheter outer sheath backwards to reveal the narrow tube. She lowered it to my urethral meatus (pee hole) and gently made contact.

"We're going in!" I uttered in a pathetic attempt to lighten the mood. Cathy had been here before and she'd doubtless heard all the banal issuances from embarrassed patients. "Just try to relax." she responded deadpan. Relax! Every muscle in my body was locked - except thankfully my ischiocavernosus and bulbospongiosus muscles - dick erection muscles. They were behaving themselves very well - as relaxed as a dehydrated cucumber.

The tip of the catheter slipped silently in to the urethral meatus and disappeared. Cathy skilfully fed it slowly into my body pulling back the flaccid protective cover as she went. "You're going to feel a little bit of discomfort in a moment as it passes through the swollen prostate. That's the narrowest part." A dunting hard pain suddenly hit me right behind my balls. I couldn't help crying out and Cathy stopped. "Would you like to take over now for the last bit?" she asked. I gathered the last of the tube and began pushing. The only pain I had was the pain of thinking I was in pain - serious man-flu pain.

A couple of inches later the end of the catheter suddenly began to flow with my pee. It spluttered and fanned out and I didn't direct it into the toilet bowl in time to stop it hitting the seat and then the floor. The sound was sweet music. I hadn't heard that sound of my piss splashing into a toilet in years and years. The sound of my bladder emptying! Fucking fucking fucking hell!

The flow continued for a few seconds before stopping abruptly. "There you go. You've done it!" exclaimed Cathy with all the gentleness of a mother comforting a child after a bad dream. "Feel better now?" Did I feel better!? The thing was - I didn't feel anything. The pain had gone. My body was without the pain of urinary retention. The non-feeling was wonderful. I stood in silence taking this significant moment in. My body had stopped hurting me. My prostate had backed off - stopped tormenting me. It was an unforgettable moment. I began sobbing quietly. The relief! Cathy just stood there giving me a moment. She knew her stuff. "Thank you so much." I couldn't thank her enough. I was drained in every sense of the word, weak at the knees and a little bit delirious and now sweating like I'd just finished a workout. "Better now I'm sure?" was all she said reassuringly. I answered with a moan of relief and "Ahhhhh I can't tell you nurse Cathy ...!"

You don't expect significant life experiences to happen in a toilet closet with a woman you don't know whilst holding your dick in your hands ... at lease I don't. You think you've seen it all but there's always something more.

As I came around, I was still holding my shrunken dick in my left hand with the spent catheter in my right. It now needed to be extracted. The thought of it coming out was nearly as bad as it going in. I began pulling it slowly. There was little resistance, just the faint sensation of something foreign rasping against the walls of my urethra. Then out slipped the back end like a train from a tunnel. One moment it had been floating around inside my bladder, the next sitting in my pee-soaked fingers. Bizarre.

As Cathy binned the catheter and I zipped up, the thought hit me that I had just been handed a solution to my urinary retention. Was I now going to be able to drain the contents of my bladder at will? Was this simple 10 inch plastic tube all I needed to stop the chronic pain I was enduring? It was an elating but confusing thought. 

THANK YOU FROM THE BOTTOM OF MY HEART NURSE CATHY.

PLEASE SUBSCRIBE AND FEEL FREE TO CONTRIBUTE

18 - CATHETER (PART 2) - THE HISTORY

Unlike many cancers urinary retention isn't a recent phenomenon caused by modern environmental factors - pollution etc. It has been around for a very long time, probably all the way back to our pre homo sapien evolutionary incarnations - DENSOVIAN - NEANDERTHAL - HEIDELBERGENSIS - HOMO ERECTUS ....

In fact there's a strong chance that as he got older Adam son of God himself had to take time out to pee more often in the Garden of Eden. Thankfully for him at that time there was no one looking so no need to go hiding behind the bushes and I'm sure Eve was too busy keeping an eye on the serpent population to notice his more frequent micturitions.

One wonders did Adam start curse not only his prostate but its heavenly inventor? Did he even ask for a factory recall? If so did God reject that on the grounds that Adam's lifestyle choices were what had caused the fault in his early prototype prostate, not its design and build quality? With no chance of Adam having spent too many nights on the batter with the lads however that's a pretty weak defence.

Could this be the first ever example of poor customer service from Heaven Inc!? 

Too much time has passed now (over 6000 years!!) and there's no known paperwork or plans to refer to so we'll probably never know unless, seeing the misery of so many ageing men down on earth, God finally decides to fess-up and take responsibility. Given his track record of keeping a low profile and not issuing statements that's highly unlikely though - it would open the floodgates to a torrent of class action litigation for faulty prostates as well as many other human medical issues. Then Heaven Inc would go bankrupt and we all know it's too big to fail.

Seriously though - what did men who's prostate had stopped them from peeing do in the olden days? Did they just die in agony?

THE HISTORY OF THE URINARY CATHETER

The word “catheter” comes from Greek, meaning “to let or send down.” Catheters were used as early as 3,000 B.C. to relieve painful urinary retention. In those times, many materials were used to form a hollow catheter shape, including straw, rolled up palm leaves, hollow tops of onions, as well as, gold, silver, copper, brass, and lead.

Malleable catheters were developed in the 11th century. In time, silver was used as the basis of catheters as it could be bent to any desired shape and was felt to have an antiseptic function.

Benjamin Franklin, the inventor and colonial statesman, fashioned silver catheters for use by his older brother John. John suffered from kidney stones and needed to undergo a daily ritual of placing a bulky metal catheter into his bladder. To make these daily requirements on his brother less painful, Franklin worked with his local silversmith on his design for a flexible catheter. "It is as flexible as would be expected in a thing of the kind, and I imagine will readily comply with the turns of the passage," he wrote to John. Holes were bored into the sides of the catheter to allow for drainage.

Coudé tip catheters were developed in the 18th and 19th centuries to facilitate male catheterisation and continue to be used for this purpose in current medical practice. Catheters made from rubber were developed in the 18th century but were weak at body temperature, leaving debris in the bladder. The advent of rubber vulcanisation, by Goodyear in 1844, improved the firmness and durability of the catheter, and allowed for mass production. Latex rubber became available in the 1930s. Dr. Frederic E.B. Foley (a St. Paul urologist) introduced the latex balloon catheter at a urologic meeting in 1935. Though he lost a legal battle with Davol for the patent, this catheter has since been known as the “Foley”. The earliest self-retaining catheters had wing tips (called Malecot) or flexible shoulders (called Pezzer), and were tied to the male penis or sutured to the female labia.

 Catheterization of the bladder was felt to be fairly safe because of the antiseptic principles of Lister (1867). But many physicians continued to be concerned about catheter-related infections as patients were still developing “catheter fever” (systemic infection) despite antiseptic principles.

After World War II, Sir Ludwig Guttman introduced the concept of sterile intermittent catheterization in patients with spinal cord injury after World War II. For many years, sterile technique was used for catheterization. In 1971, Dr. Jack Lapides of the University of Michigan at Ann Arbor introduced the clean intermittent catheterization technique. Dr. Lapides’ theory was that bacteria weren’t the only cause of infection. He believed that chronic stagnant urine residuals and overstretching of the bladder were also responsible. But the fact that CIC was not performed in totally sterile conditions, Dr. Lapides still felt it was superior to indwelling catheters. Initially, Lapides was scorned in the urology world. Three decades after this debate, clean intermittent catheterization remains the preferred method to treat chronic urine retention and neurogenic bladder. Recent regulatory changes have recommended against the reuse of catheters for IC in an attempt to further reduce the risk of catheter-associated urinary tract infections.

References: 

Carr, H. A. (2000). "A short history of the Foley catheter: from handmade instrument to infection-prevention device."  J Endourol 14(1): 5-8.

Ellis, H. (1988). "Therapeutic milestones. The Foley catheter." Br J Clin Pract 42(6): 248-249.

Lapides, J., A. C. Diokno, A.C., et al. (1972). "Clean, intermittent self-catheterization in the treatment of urinary tract disease." J Urology 107(3): 458-461.

Marino, R. A., U. M. Mooppan, et al. (1993). "History of urethral catheters and their balloons: drainage, anchorage, dilation, and hemostasis." J Endourol 7(2): 89-92.

Mattelaer, J. J. and I. Billiet. (1995). "Catheters and sounds: the history of bladder catheterisation." Paraplegia 33(8): 429-433. 

Nacey, J. and B. Delahunt. (1993). "The evolution and development of the urinary catheter." Aust N Z J Surg 63(10): 815-819.

TO BE CONTINUED ....

17 - CATHETER (PART 1) - DON'T BE WORRYING ABOUT YOUR URINE NOW!

I'm now a huge fan of the catheter. 

In my life they have been incredibly important on a number of occasions. Such a simple piece of equipment with a great pain and pee relieving capacity. They really do take the piss out of you!

My first experience of catheterisation was in September 2010. I'd fallen out my upstairs bedroom window during the night. I was either sleepwalking or heading to the loo for a pee but I'll never know which because the memory was knocked clean out of me on impact. 

I landed in the garden 17 feet below. Apart from flashbacks of the ambulance ride through the Wicklow mountains to hospital I don't recall much after that until I came round in a north Dublin hospital ward surrounded by anxious family. 

The following days and weeks weren't easy. I'd broken a few bones in my neck so the medical people had put me in a straight jacket to stop me moving - body, neck and head all bolted together in a frame. My arse and thighs were a blended colour combination of green, blue, piss-yellow & pure ink black caused by bruising from the impact. The biting chronic pain from that was very profound and I have much to thank my dearest friend morphine for, for being there when I needed it! To be able to self administer with my very own analgesia pump was blissful release when the pain got too much to bear.

In the midst of all the turmoil there was some good. Days after surgery I suddenly had a worrying thought. I hadn't been to the toilet since arriving in the ward so where was my fecking pee going? Even then it seems that urinary retention was on my mind.

I quickly brought this to the attention of a nurse fully expecting her to press a panic button and have me rushed in to surgery but she just smiled awkwardly and told me "You are with a catheter Mr Woods. You don't have to be worrying about your urine now!" That took a while to sink in.

Catheter!? ..... Me!? ..... Ca-the-ter!? ... WTF!!!?

Back then I knew very little about catheters. I was young - like! Catheters were things that old people had to use because their ancient innards didn't work anymore, so the words 'you' and 'catheter' used in the same sentence did not compute.

Men are very protective of their nether region. It's where their crown jewels are kept warm and safe and separated from the hostile world around. The thought of them being interfered with surgically is the stuff of cringing, wincing and nightmares. The idea of a tube being pushed up your dick just isn't an easy thing to accommodate - and without one's own consent! 

The bottom line is - stuff comes out your dick - it isn't meant to go up it! That just isn't natural! 

Being confined to my hospital bed I didn't dwell on that for long though. Not having to piss from one end of the day to the other was simply wonderful and I adjusted instantaneously to the new order of things - the simple, painless penile intervention. That catheter was a keeper!

After leaving hospital there was an 11 year gap until my next catheter encounter. I wish it hadn't been that long.

In 2021 my dad started using an indwelling catheter - one you don't remove. He had his own prostate problems and couldn't control his pee. His carers drained the attached leg bag several times a day and fitted a night bag before he went to sleep. To say he was very glass half empty about this is an understatement. Whilst allowing their use (he had no choice) he absolutely detested them, but they were a necessary evil from which dad's quality of life was much improved (and the amount of time my mum spent doing laundry!) You could tell however that he was discombobulated by having the penis he'd had life long single control of being manhandled by ladies he trusted and respected but didn't know. Whilst I presently see catheters in a positive light I can't say I'm looking forward to the arrival of that day in my older age.

16 - HAVING A POT TO PISS IN - THE GOLDILOCKS CUP

Let's face it - even in 2023 there are many advantages to being male - broader job opportunities, bigger pay packets and of course no bloody monthly period to deal with. Being able to pee standing up at a urinal without removing layers of clothing is WELL up there as are the far more numerous public toilet fixings available to us.

 

I mean what caballe of women-hating male architects is it that continues to stamp its mark on female toilets the world over with a "give them a couple of cubicles and let them line up and wait" approach to toilet (restroom) design?

I've always felt a bit guilty walking past the women queuing outside the female toilets whilst I head straight in to the men's to pee. Recently however I've come to accept and appreciate the thinking. In fact from where I'm standing it's simple - veeeeerrrrry simple. Women don't have a prostate ergo women can hold their pee. Bingo!! Line them up baby 😂!!

Public toilets have nevertheless come to be a place of disappointment for me. It doesn't matter how many urinals there are if you can't even piss properly in to one of them. For this reason my visits have dwindled to a trickle over the last years. 

When you're urgently needing to piss 5 or 6 times an hour it's not practicable to find a pot to piss in every time. You have to find a more immediate, convenient and private way to meet your urgent urge. 

For many years I used the roadside when driving - finding somewhere out of public view. These days I prefer to piss in a pot in the comfort of my own car - my mobile urinal! With recent disclosures about Amazon drivers having to do the same I'm no longer shy about admitting this - I really don't give a damn. Besides I know for a fact from talking to fellow prostate-heads that I'm far from alone. We piss-in-a-potters are legion!

If it shocks or surprises you to read about my car seat-pot-pissing then I congratulate you on your continued membership of the exclusive Club Urinal - where the pee flows freely night and day. Please just try to avoid mockery - it could well be you before too long.

I started pot-pissing about 7 years ago after the blackout I described in the post titled 'DRIVING ON - HOLDING OFF'. Since then I've honed my car seat urination technique and established which receptacles get me the best most sanitary results.

There are now many purpose made contraptions for capturing your pee - a strong indication of the demand that's there for the need they serve - but I've never used any of them.

I'm a bit old school and I prefer to repurpose used containers, whatever is to hand in the footwells of my untidy car 👊 ...

I've used empty yoghurt cartons, cut off soft drink cans, plastic bottles, tetrapack cartons, even crisp packets and plastic bags at a pinch. All these function passably well as a means of gathering pee and so avoiding saturating the seat between my legs but in one way or another they aren't an ideal fit. 

With anything cut off there's the real risk of cutting yourself on the ragged edges. As with a nick from a razor blade whilst shaving, a drinks can cut can take some time to heal so try very hard to avoid!

With the wrong sized or shaped containers there's the risk of splashing, overflow and spillage - especially if you're driving. Avoid this at all cost unless you never carry passengers in your pungent smelling vehicle!

                                                                              

One container has become my go-to favourite: the modest, disposable regular size double walled coffee cup. It's my 'Goldilocks cup' - neither too big nor too small, but just the right size.

As a between the legs pee collector it ticks every box - 

* It's sturdy but flexible. ✔️

* It tucks nicely between your cock and your balls thus preventing back dribbling into your pants. ✔️

* It's big enough to hold a decent amount of pee but not too big to be cumbersome. ✔️

* It's wide rimmed, enabling fast and easy knob placement when you're in a hurry. ✔️

* The rim is made from soft moulded cardboard so there's no risk of chaffing or cutting. ✔️

* The sides are flexible and can be squeezed to fit between your thighs. ✔️

* Once you've peed you can reshape the cup and fit the lid on to prevent spillage.

One warning of your thinking of going out and getting one for your own use - don't forget what's inside and take a lazy swig. If you do you'll be in Helen Mirren country!

If

Though it's been years since I drank takeaway coffee I keep one of these cups between the seats in my car at all times.

There's a knack to peeing in a coffee cup in a way that ensures you don't end up dribbling over yourself after you think you're finished. It isn't easy but with a bit of patience and practice it's doable.

Never forget about the contents of the pot you've pissed in - empty them out as soon as possible. Whilst the actress Helen Mirren believes in the medicinal power of drinking a little of your own freshly peed pee every day I don't recommend taking a gulp without knowing what you're about to swallow. Day's old urine can't possibly be good for you!!

15 - NOT A DROP - URINARY RETENTION

With a normal functioning bladder all of or nearly all of the contents are evacuated when you pee leaving the bladder dry-za-bone and the muscles blissed out relaxed. They stay that way until the next time it's full, then once again they have a bit of a contraction to let you know you'll need to get your arse in gear shory. It's mind and body working in perfect harmony. Such a wonderful thing.

When you develop problems with 'urinary retention' this symbiotic relationship is broken down. The hitherto smooth flow of piss out of your bladder is interrupted or halted. Communication breaks down and plumbing work comes to a standstill.

What causes urinary retention?

• enlarged prostate, or benign prostatic hyperplasia.
• bladder outlet obstruction, such as urethral stricture or scar tissue in the bladder neck.
• pelvic organ prolapse, including cystocele and rectocele.
• urinary tract stones, also called calculi.
• constipation.

At every stage of my 'old man's bladder' pee problem as I struggled with my belligerent penis and waterworks I've been inclined to think "This has to be as bad as it gets!", but it never has been. My water workers have always had the capacity to go that extra mile - to tighten the screw just a little bit more. They have been nothing if not determined to give me every last drop of urinary excruciention.

Having to pee urgently and frequently is very unpleasant. It's painful, exhausting, embarrassing and demoralising. What on earth could possibly be worse? I could never have imagined. 

Much worse - so much shaggingly awfully pissing worse - is not being able to pee at all - NOT A SINGLE DROP. That's a whole new level of suffering.

TORTURE - verb - to cause great physical or mental pain to someone intentionally

Sometimes in life you have an experience that's so powerful it changes your perspective on the world you thought you knew. In 2004 I had one of those experiences. I visited Auschwitz-Birkenau concentration camp in Poland - where the Nazis murdered millions of people, mostly Jews during WW2. The person I left there as was not the same person who arrived. It was a profound and humbling experience.

The level of inhumanity to which the 'inmates' there were subjected was everywhere to be seen - in the barbed wire fences, the gas chambers, the human bone fragments still lying under foot around them. The horror. 

For me it was truly brought home in one location - Block 11 - the punishment, torture and execution block. Here the Nazis 'dealt with' attempted escapees and suspected saboteurs. Of the many punishment methods meted out in that building one took me to a very dark place from which I've never fully returned. It involved the confinement of detainees in standing cells.

These standing 'cells' were four human body spaces wide and the depth of your chest. Entry to this confined space was through a small opening at floor level through which inmates crawled up to a standing position. Four prisoners were confined there side by side for the night. The only source of air was a 5x5 cm opening covered with a metal grille. They couldn't move. They couldn't lift their arms, sit down or even bend their legs. Then in the morning, if still alive, they had to go straight out to work. This punishment was applied for periods from several nights up to several weeks in a row. 

I will never get my head or emotions around the cruelty of this. The pain and distress is unimaginable. It is pure physical and mental torture combined. A living hell. It still leaves me in despair when I think about it. The phrase 'There but for the grace of God go I' always comes to my lips even though I'm not religious.

A LIVING HELL OF MY OWN MAKING

The grace of God did not help me during my own pee torture. 

I'm not a specialist but I think I'm right in saying that you can't physically torture yourself - that's called self harm. But when your body is subjecting you to such excruciating pain isn't that differentiation kind of irrelevant? - your body is just fucking torturing you. That's how it feels and that's how it is.

Missing a couple of important nuts and bolts, over time my unintelligently designed Friday afternoon bladder gradually stopped evacuating itself. A good half pint of pee became a reasonable teacups worth. That evaporated to a shot glass amount which then sometime during the winter of 2021 reduced to a thimble full and often just a few drops that didn't even have volume enough to fall off the head of my dick. Then very often nothing at all - not a drop. 

Going to the toilet no longer meant GOING to the toilet. It meant going in to a room with a toilet in it, standing above the bowl, desperately stifling screams of pain as I watched nothing happen down below.

Once I'd peed nothing or the very small amount my body would allow I still felt the exact same desperately urgent need to pee. The feeling is complex but I'll try to explain ...

You desperately need to pee. Your penis is burning up like there's a lit sparkler inserted up it. You feel like you are just about to piss yourself - you can barely hold it in (that's what you think and feel you're doing anyway) so you go to the toilet, but when you unzip, point and release, absolutely nothing comes out and the feeling doesn't go away - not one little bit. 

You stand there straining. Your brain is shouting "Release release you can release now!" - but the same brain knows you have already released. You've turned the key but the engine hasn't started. You've pressed the button to open the dam but the floodgate isn't moving.

Your body is screaming "Fucks sake piss NOOOOW you silly bastard!" but it's you - your own body that is stopping you. Your piss is being held back further up the line. You can't escape the pain because it's a part you. You can't do anything to get rid of it because the only means to do so is to pee and you fucking can't do that!  It's unbearable but you must bear it. There is no escape from it. You are locked in to it. It's torture in everything but name. It's pure torture but your torturer is yourself.

This goes on and on. Your mind and body are in a state of severe distress as you stand there dick in hand. Eventually after standing there forever you accept there's no point in waiting any longer so you zip back up and leave the urinal/ restroom. Every step you take away from it doesn't make sense because your body is telling you that you need to be back there peeing. 

What's so cruel though is that as you go back to the world outside your bladder muscles now move to hold your pee in! They contract the already contracted muscles. That leaves you in a state of complete agony and bodily confusion. You are trying desperately NOT TO PEE. It doesn't make any sense. You don't know whether you are coming or going. 

This is the life I led for over 2 years until I found a solution, one that had been staring me in the face for years.

13 - DRIVING ON - HOLDING OFF

BEYOND PAIN

When experiencing extreme pain - literally 'unbearable' pain - the brain 'disconnects'/ switches off in order to prevent further system damages resulting from the overbearing pain. It renders you unconscious. Unconsciousness in this scenario is the brain's 'fuse' tripping. 

It's summer 2016. I'm driving from Dublin to Belfast, a journey I do frequently. It's 2 hours on a good day - far longer than I'm able to hold my pee so I have my regular places to stop at the side of the road. Not being brash, uninhibited or thoughtless enough to just go right there on the roadside in full view of passing motorists I always go out of sight - mostly in fields where I've often relieved myself in front of an audience of inquisitive cows .... and boy oh boy can they pee!?

Today though I'm on the way to a family barbecue that has already started. It's the weekend. The sun is splitting the sky and I don't want to waste any time stopping so when the urge to go arrives about 30 minutes north of Dublin I decide to ignore it and keep driving. Over the next 30 or 40 minutes the urge comes and goes, each time the detrusor muscle contractions growing a bit stronger and more painful. (Could this be what labour is like before childbirth!? Different muscles I know, but it sounds so similar) Pressing the tips of my fingers hard in to my groin area helps dull the pain.

I get to the outskirts of Newry, a grim town just north of 'the border'. Only 50 more minutes or so to go, but by now the pain is making me cry out. Nevertheless I still resist my bladder's severe warnings. I'm sweating now from the physical effort of urine containment but I'm determined that I'VE GOT THIS! 

Then the coming and going of the muscle contractions stops. They are suddenly replaced by a continual blindingly painful contraction that sends a solid sheet of cramps out around my bladder filling my lower torso and groin. Now I fucking have to stop the car! I can't go on. 

I start crying out in agony. My body screams "Scream you useless fucker - SCREEEEAM!" I couldn't stop myself even if my life depended on it. The pain is overcoming my brain so much that I can hardly see the road to look for a place to stop. Delirium has set in. This is much worse than I've ever gone through before. I'm in uncharted territory.

I jerk the car off the road. This time I'll pee anywhere when I get stopped. There's no time for caring. Steering in to the layby there's an open farm gate in to a field right in front of me. The car jumps as the wheels leave the tarmac and hit a deep muddy dip across the threshold in to the field and comes to an abrupt stop. 

I pull the door release with great difficulty but the pain is now too great to push it open. I've completely seized up in the seat. Any movement is crippling. In my nightmarish fever pitch I have a ridiculous but frightening thought - that I'm not going to survive this. Seizure .... panic .... 

That's the last I remember .... blackout .... coming round some time later lying on the ground outside the car in the sun. My face is pressed painfully in to the hay stubble. I am confused, disorientated and exhausted like I've just had marathon sex whilst running a marathon. I lie where I am for some time just gathering strength. White noise sound of passing traffic on the road beyond. 

Peeling myself off the ground takes a lot of effort. I am wet with sweat and I've pissed myself. I am still in a lot of cramping pain but it isn't anything like before. I can move, but can't stand up straight. I'm not in a fit state to drive. I fit myself back in to the car. I shouldn't turn the key but of course I do.

The family barbecue was great ... I think. I have no recollection of it other than that it happened after the above.

At the beginning of this blog when I was just getting going I asked the question - "... is it just me?' Now, recalling and writing about this incident I realise that in this instance it is just me. Of course it bloody is! What other masochistic cretin could there be walking the planet who'd put himself through this torture and STILL not do anything about it!? 

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12 - FACEBOOK GROUPS AND POSTS

Since publishing this blog I've started to use Facebook to find groups committed to prostate related issues. There are quite a few. They have been set up all around the world and deal with everything and anything prostate related. 

As I begin to read the regular posts from fellow BPH sufferers a couple of key themes are emerging.

Many posts are added by men either approaching or in recovery from their first hoLEP (holeum laser enucleation of the prostate) or TURP (transurethral resection of the prostate)

They are seeking advice on whether this is the right surgery for them to have and what to expect from it.

I'd never heard of hoLEP before now. It wasn't discussed with me by my doctor or surgeon. TURP was the only option.

From what I've read there are a number of differences between the two proceedures. The most significant is that hoLEP (a day proceedure) uses laser technology whereas TURP (an in-patient proceedure) uses a heated electrical loop. The implications of this vis a vis hospital in patient time, recovery time and complications are various, but from what I can tell they both have a broadly similar result - the removal of pieces of the prostate from the pathway of the urethra. If you're interested in reading first hand accounts join those prostate related Facebook groups. New contributions are being made all the time.

At the end of this post I've added links to a couple of hoLEP/ TURP related internet articles, but of course there are many others you can easily find through your search engine.

In case it's of interest here's a short step by step account of my TURP proceedure and the aftermath:

July 25th 2023 - Tuesday

Admitted to hospital in Dublin

Operated on later the same day under general anaesthetic.

Proceedure took under an hour.

Woke up in no pain (but some discomfort), fitted with a catheter. Confined to bed. Took pain killers. No food, only fluids.

July 26th 2023 - Wednesday

Advised to get out of bed and walk as much as possible.

Did 8 or 10 rounds of the ward during the day. Walking wasn't painful but was awkward with catheter and bag strapped to leg. Took pain killers. 

July 27th 2023 - Thursday

Catheter removed late morning. Took pain killers. Completely unexpected emptying of bladder about half an hour later - complete incontinence - but this was the first and last time (there was always a very short painful warning thereafter - though no possibility of stopping the flow)

First proper pee about an hour after that - big flow/ 5 seconds followed by blood and prostate debris.

Plenty of brisk walking around the ward.

Urgent need to pee small amounts througout rest of day and night and much leakage. Blood in urine.

July 28th 2023 - Friday

 Discharged from hospital. Continued urgent need to pee and leakage. Blood in urine.

July 29th - August 23rd 2023

Continued urgent need to pee small amounts and full uncontrollable emptying of bladder (incontinence??) several times a day - I called this 'incontinence', but my surgeon preferred to call it 'leakage'. Technically he may be right given that the 'urgent need' meant there was some warning - no matter how small - whereas with incontinence apparently there isn't any warning. Blood in urine.

August 23rd 2023 onwards

Blood in urine stopped on August 23rd. Continued urgent need to pee small amounts and less regular uncontrollable emptying of bladder for around 5 more weeks along with constant leakage. 

Follow up consultation with surgeon on September 6th. Peed myself in the meeting! He prescribed Vesomni - a bladder muscle relaxant and assured me that my delayed recovery was due to a prolonged period of stressed bladder muscles pre TURP and it would come right.

Today - October 20th 2023

Continued urgent and frequent need to pee small amounts, but that was mixed with periods of less urgency/ much greater flow and seems to be reducing gradually. No more incontinence, but continuation of 'leakage' though that too is reducing gradually.

Am now peeing 3 - 5 times at night - usually larger amounts each time. Lying down seems to help.

For comparison between TURP and hoLEP read:

https://pubmed.ncbi.nlm.nih.gov/19570488/ 

For more info on hoLEP surgery see:

https://www.hopkinsmedicine.org/health/conditions-and-diseases/benign-prostatic-hyperplasia-bph/prostate-holmium-laser-enucleation-holep#:~:text=HoLEP%20uses%20a%20light%20beam,prostate%20size%20and%20patient%20health.

For more info on TURP surgery see:

https://www.nhsinform.scot/tests-and-treatments/surgical-procedures/transurethral-resection-of-the-prostate-turp/#:~:text=A%20transurethral%20resection%20of%20the,the%20bladder%20to%20the%20penis).

MANY MORE POSTS TO COME - PLEASE SUBSCRIBE FOR UPDATES

If you are enjoying and/ or find this blog helpful please subscribe and contribute if you feel able. Having spent the past weeks connected to a number of prostate related Facebook groups, I've seen that other sufferers are looking for information to help them understand and deal with their condition. I have no doubt there are many - many stories and experiences out there around the world of men. My aim in this blog is to provide a platform for just that. There are so many of us and I really think it would be valuable to share. Thanks