21 - POST-OPERATION UPDATE ... INCONTINENCE & ALL THAT JAZZ

I had my TURP operation in July 2023. Two years and 4 months have now passed since I started to get my life back. When I say 'started' it's because it took time for my system to adjust to a sort of pee-normality and even more time to get back to the life I'd had before UR had taken it away. In facebook prostate groups the question is often asked - "How long will it take to get back to normal?". There is no standard answer to that because every individual's experience is different. Hence all I can do is describe my own post-op experiences and hopefully give others an idea what they may have to look forward to.

POST-OP IN-PATIENT RECOVERY

Even the length of the hospital stay seems to differ between TURP patients. I have read many online posts in which the patient said they were released the same day as or the day after surgery. This never fails to surprise me because although the surgery is not highly invasive and the post-op pain level is minimal the patient does waken up fitted with a catheter linked to a drainage bag strapped to their leg or hanging at the end of the bed. This is needed to prevent their newly cored out urethra from coming into contact with their urine, allowing it to heal. It's also needed to provide unimpeded irrigation of the bladder as well as to reduce the possibility of post-op swelling and bleeding.

Patients who are sent home soon after surgery leave hospital fitted with a catheter which then has to be removed by their doctor or a nurse in a medical centre.

I spent 4 days as an in-patient. I was treated privately which perhaps explains the duration. On the day after the op I was told to drink as much fluid as I could and to exercise as much as possible. Nurses regularly did the rounds changing our water jugs and encouraging us to drink drink drink. I took to walking the ward three or four times a day. In the corridors I came across other patients doing the same. With all of us hauling a catheter stuck up our dicks we walked with a bit of a waddle and must have looked like blokes in the early stages of transitioning to be penguin.

I wasn't in a hurry. The chafing of my penis and the catheter tube against the inside of the nylon hospital gown saw to that! I had no pain, just a bit of discomfort but the thought of making the wrong move was constantly on my mind. I looked at the doctors and nurses hurrying around freely and felt very self conscious. Even in a prostate ward that felt a wee bit awkward.

On day three I was told to remove my catheter by myself after breakfast. That happened in the ward toilet. I have described the experience in the post titled '2 - PEE AT LAST'. It was an extraordinary experience! The pleasure I felt from that first pee is still with me to this day.

From then on I was directed to drink as much water as I could in order to flush the bits of my post-op urethra out of my bladder. Each pee brought new bloodied lumps but they quickly reduced in frequency. The only issue subsequently was that I wasn't always making it the 4 metres from my bed to the toilet in time. Incontinence had become an issue. I'd never experienced that before but my surgeon who did the rounds every morning assured me this was normal and it would soon stop.

On discharge from hospital I walked out the revolving door into the fresh air and sunlight with some  trepidation. How could I already be free to go? My incontinence hadn't stopped and I was facing a two hour bus ride home. I hadn't planned ahead for this by bringing incontinence pads with me so it was going to be pot luck whether my bladder would keep its mouth shut .... and I was wearing light tanned trousers!

My bladder did its own thing and I was leaking within 20 minutes of getting on the bus. I used an abandoned newspaper as a makeshift incontinence pad and so avoided leaving my cushioned seat drenched for the next unsuspecting occupant. By the time I'd arrived home I was soaked. 

The experience of incontinence is strange and un-nerving because it comes not from a bodily feeling but from lack of feeling where you have always been used to one. There is a specific but subtle 'sensation' of peeing that comes from the process of allowing your bladder muscles to loosen to allow pee flow. It is a satisfying feeling. There is no such sensation with incontinence. You don't 'decide' to pee -  to relax your muscles. They do that all by themselves without warning. The result is that your urine flows into your crotch unannounced. Suddenly it's there following gravity and the line of least resistance and you are warm-wet.

Going from full urinary retention to incontinence in the space of four days is a lot to deal with and I got very confused.

INCONTINENCE VISUALISATION ....

Think of your crotch as a dry river bed in the desert. It is parched but somewhere out of sight and sound a dam has been opened. You have no knowledge of it. Suddenly out of nowhere a fast moving wall of water appears and fills your river bed with an unstoppable flow of water. The bone dry desert landscape has become a flood plain. That's incontinence. 

In the following days there was no improvement. I wet myself several times a day and didn't leave the house. I stifled the thought that this might be my new reality by reminding myself that my surgeon had promised it would "come right" as he put it. Permanent incontinence can be a side effect of TURP so I focused on the idea that it would be so much better to be peeing myself uncontrollably than not being able to pee at all. With the choice between wearing incontinence pads for life and self-catheterising, incontinence was an infinitely preferable terrible state to be in!

The follow up appointment with my surgeon took place two weeks later in his Dublin 'rooms'. I had peed myself on the way there. This time my jacket had to replace newspaper on the seat of the bus - I'm a slow learner. Thankfully it was a warm day so I had no need to wear it. The meeting lasted less than 15 minutes. He asked me how I was and I brought up the incontinence to which he replied "Nooooooo!?" in a slightly patronising tone with a look that suggested he didn't believe me. I lifted my damp jacket off my crotch to reveal my 'pissy pants'. It was a 'slam-dunk'. With more assurances from him I left the consultation and have never seen him since.

Thankfully in the end he was right. The uncontrollable gushing slowly reduced and then stopped and within a month I was fully in control of my bladder. It took around six more months for my pee-flow to become balanced and predictable. One thing however never got back to normal.

As we blokes know - two fluids flow out of our penis. The main one - pee/ piss/ urine - is a daily norm. It contains all the waste from our food and drink intake - urea, uric acid, sodium, potassium, salts and hormones. Getting rid of that is vital for our health. The other fluid is the stuff of procreation - full of life giving properties .....

22 - TURP SIDE EFFECTS - ORGASMS, RETROGRADE EJACULATION & LIBIDO

MY SURGEON GAVETH AND MY SURGEON TOOKETH AWAY

There are multiple surgical procedures for BPH. The first and until quite recently the standard one is TURP (trans urethral resection of the prostate) It was first introduced in 1926. There is no figure for the number of men who've had TURP, but you get an idea of how common it is by the number of ops in just the US each year - 150,000. In Germany between 2005 and 2022, 1,355,845 surgeries were performed - nearly 80,000 per annum. The global annual number must be more than a million.

Each different procedure (HoLep/ aqulablation etc) has potential side effects. You can easily find these eon the net. The most feared one is retrograde ejaculation or 'dry orgasm'.

With the prostate being a vital organ for the production and distribution of semen the potential for semen flow to be affected during surgery is high and it is the most common side effect of TURP with rates of occurrence estimated to be between 65% and 90%. There are no surveys, but my reckoning from spending years reading online posts is that 90% is a more likely figure.

THE TURP PROCEDURE

The TURP procedure involves shaving away prostate tissue through the urethra. During this process damage may be caused to the muscles of the neck of the bladder (internal Sphincter) or the nerves that control it. This may prevent the bladder neck muscles from closing during ejaculation. As a result semen travels backwards into the bladder instead of being ejected through the urethra/ penis. This is called a 'dry ejaculation'.

Key points about retrograde ejaculation after TURP:

Mechanism: During a normal ejaculation, the bladder neck muscle tightens to prevent semen from entering the bladder. The TURP procedure removes prostate tissue near the bladder neck, which can damage this muscle, causing the semen to flow backward into the bladder instead of out the penis.

• Symptoms: The primary symptom is little or no semen produced during orgasm, which is sometimes called a "dry orgasm". After orgasm, the semen leaves the body during the next urination.
• Impact: Retrograde ejaculation does not cause pain or affect the pleasure of an orgasm. However, it does cause infertility, which can be a significant concern for younger patients wishing to have children.
• Other side effects: While other complications like temporary urinary incontinence, bleeding, or urinary tract infections can occur, they are generally less common than retrograde ejaculation. 

Patients should discuss potential side effects including retrograde ejaculation and its impact on fertility with their surgeon before deciding on a TURP or a potential alternative procedure, such as a prostatic urethral lift (UroLift) which has a lower risk of this specific side effect. 

HOW ORGASM AND EJACULATION WORK

Here's a link to a video that succinctly describes the anatomy of RE:

https://youtu.be/HxI2zft2y18?si=ECLe2w_AD8FFwba3

There are two different processes going on during orgasm and ejaculation.

Orgasm is arrived at and controlled through both physical and mental arousal. It arrives through a complex interplay between the brain and the body. It involves physical muscle contractions and hormonal responses while also activating numerous brain systems related to emotion, pleasure and thought. It is complex!

Ejaculation is physical and completely involuntary. During ejaculation the body takes over. The Semen is pumped by a combination of smooth and striated pelvic muscles, including those of the prostate gland and the bulbocavernosus muscles in the penis. The prostate's smooth muscles contract like a sponge to expel fluid, while the more powerful rhythmic contractions of the bulbocavernosus and other pelvic muscles force semen along the urethra and out of the body. The physical contraction and expansions can be felt strongly.

MY EXPERIENCE OF RETROGRADE EJACULATION

I have RE. Having known nothing about this side effect before I had the operation I didn't find this out until my first attempted orgasm some weeks after surgery. Neither my doctor nor consultant had mentioned it as a possibility and I was never given the option of another procedure. I didn't do any research. After waiting 5.5 years for surgery, when the letter came through the door offering TURP I just agreed. RE or any other side effect was last thing on my mind. I really didn't care about anything but getting out of the nightmarish situation I was in with full retention and to be completely honest, had I known, I would have gone ahead anyway. I therefore have no regrets**. That positive attitude is not however shared by many of my fellow TURP travellers. Many are thrown into deep distress and depression by the experience of RE and I do understand why. The change is enormous.

** see below

Feelings are subjective so it is difficult to describe them, but here's a stab ....

In my 48ish years of post-puberty life and many thousands of textbook orgasms on the score card I never really tried to dissect or deconstruct the various stages they went through or the resulting feeling they gave me. Whether during intercourse or self-administered it was always just one great big full bodied orgasmic pleasure that never failed to satisfy - like an Ardbeg whisky or Eggs Benedict.

Despite not having had a normal 'wet' ejaculation for 2.5 years that powerful experience is still vivid in my imagination. Some feelings are impossible to forget. Perhaps now however, with parts of my sex organs removed I am well positioned to describe what you don't get with the dry version.

What you do get with a full wet orgasm - 

1        rising arousal - all cylinders firing

2        climax

3        orgasm - peak pleasure - brain triggered

4        ejaculation reflexes kick in

5        involuntary muscle contraction and semen pumping hard

6        slow 'come down' with muscles still pumping more gently

7        continued diminishing arousal as muscles slowly stop pumping

8        relief, relaxation and satisfaction

The first 3 of the above steps are experienced in exactly the same way during a dry ejaculation but there the comparison ends. It ends just after the ejaculation and before the discharge of semen. The 'involuntary muscle contraction' and pumping of semen doesn't happen. The semen has been ejected from the balls straight into the bladder so there is no physical need for the penis muscles to contract.

How to explain this in terms of a bodily 'feeling'? I can't!! It is so powerful and so unique a feeling that after days of trying I can't think of an alternative. It has no comparison. It is the ultimate physical pleasure a body is able to experience.

Perhaps I can get somewhere with describing the emotional side of the experience. The words - letdown, underwhelming, vapid, insipid, joyless and deflating come immediately to mind. Having known and loved the full effect of an ejaculation for so long the difference is huge. You go from high excitement to sudden disappointment in an instant like being overtaken at the finish line in the last second of a race. You were up for it, you invested everything you had, your expectation was high but you didn't come first .... you didn't come at all. It isn't a climax; it's an anticlimax. 

It's odd that although 'peak pleasure' is technically reached at orgasm a dry ejaculation gives nothing like the pleasure of a wet one. You have achieved the moment of greatest arousal but the full follow-through pleasure of physical ejaculation doesn't arrive. Without that the orgasm sensation quickly dies away leaving just a fading memory of what once was and a longing for what could have been. The orgasm has nothing to follow through on. It is left high and dry.

Looking online for reasons why a dry orgasm is disappointing I read 'Most people associate orgasms with the visible release of semen. When this visual release component is missing, the experience can feel unusual or unsatisfying.' This doesn't do it justice. I don't think the 'visible release' is relevant. It's the physical release that matters - the feeling of your penis muscles pulsating and pumping that gloopy teaspoon full of semen out of you. That delicious feeling is to an orgasm what MSG is to Chinese food - it brings it to life. Without it everything before it loses its context - its purpose. Psychologically that's a tough thing to deal with. You are wired to expect a course of meat and 2 veg. Each requires the other for it to be a proper meal. Take away the meat and the veg is an insufficient letdown.

RETHINKING MY POSITIVE THINKING - LIBIDO

Whilst I have no regrets about TURP surgery, now that I'm thinking hard about its consequences I realise that without ejaculation I am half way to every man's worst nightmare - emasculation. I still have my balls but their contents will never see the light of day or the darkness of a welcoming vagina again. They'll all end up mixed into my pee and flushed into a toilet bowl. I'm one step below a shooter of blanks. Nothing fires out the barrel of my gun. It has been deactivated.

Masturbation is free. You can do it any time you want as often as you want. The only tool you need is your hand and your cock. It along with consensual sex gives more physical pleasure than any other activity known to wo/man. Being free at the point of delivery the full orgasmic experience is an extremely valuable one to have to hand.

Thankfully I have already had my kids and my sexual needs have always been modest. I am happily single and even before TURP I didn't crave or value regular or random sexual contact. Having the odd tug on my todger was always a welcome pleasure though. It released stress and made me feel good. I have noticed in the last months though that natural sexual arousal is happening less often in me. When I masturbate it's not just a simple pleasure. It also comes with an eye on the 'use it or lose it' principle of neuroplasticity. Its purpose is now becoming to service the machine to prevent it seizing up.

I often now do it just because I haven't done so for weeks and know I need to keep my hand in. More and more, without the great pleasure I used to experience, it is a chore. Before TURP, I never had to remind myself to have a wank. My cock always told me when it was time. I do miss that a lot.

The fading of the sexual drive (libido) is associated with old age. I'm 60 and hopefully have a few years left on the cock. I now look forward to those years without the certain knowledge that I can 'pleasure myself' at will. I've already stopped even being interested in a bit of cleavage or a beautiful ankle. I used to be aroused in a 'look, don't touch' way and just enjoyed the beauty of the female human form. That's normal for both men and women, old and young, so a waning in my interest now adds to a sense of detachment from my fellow human beings. Men are estimated to think about sex 19 times a day on average. I now think about my failing libido more often.

Soon after TURP the discovery that I no longer felt the full pleasure of sex was unexpected and concerning but I got over it by focusing on the pleasure of no longer having the pain of retention. I also believed that in time this would probably change or I'd find a 'work around' to get my mojo back. Since then I have certainly found ways to enjoy it more than I did at the start. 2.5 years on I reckon I'm getting the best experience I can out of it - maybe 60% of what I had before. Perhaps a few percent would be added if I could now just fucking forget the way it fucking used to be! Once you've driven a Mercedes no other car comes close.

WOULD I STILL RECOMMEND TURP?

Yes I would for those who have no alternative. However with the recent arrival of less invasive procedures I would say .... "Don't do it!" There are so many alternatives. Some, like HoLEP have a similar chance of causing RE, but others are much less likely to do so and I recommend you consider them. If you want advice you should talk to your doctor or join a couple of Prostate related FB groups where you'll be able to read about the experiences of men who've been through them. There's also lots of medical information on the net to help you make your decision.

MAY THE FORCE BE WITH YOU!

20 - CATHETER (PART 4) WHY AREN'T THEY AVAILABLE OVER THE COUNTER?

These days UR/ BPH is treatable and so not generally life threatening. A diagnosis is in no way as stressful as one of cancer or MS or many other conditions that can be horribly painful and debilitating and ultimately fatal. Yet the pain of UR is one of the worst pains a man can have and if it's at an advanced stage it doesn't go away - even with anything but the most powerful pain medication. Without access to a catheter it can't be taken away. That's an odd contradiction - extreme pain that's able to be relieved without drugs and not able to be relieved with them.

If I had a list of simple pain relief medical interventions, the catheter would be at the top above bandages and morphine and anaesthetic. Why? - because they have the ability to remove excruciating pain in a matter of seconds without the use of any drug.

Unless you've had experience of a catheter they seem far removed from your normal healthy life. To most people they're unsettling contraptions that are only used on really sick people ... not you! The thought of them makes us uncomfortable. We cringe a little! After all don't they have to be inserted inside you by a nurse!?

You can buy catheters online, but with millions of men suffering from chronic retention it seems like they should be more readily available over the counter in chemists and even supermarkets in packs of 1 - 2 - 5 - 20. The reason for this not being the case is described thus:

'Catheters are genearally not available over the counter because they are medical devices that require proper selection, sterile insertion, and management by a trained healthcare professional to prevent serious complications, primarily urinary tract infections (UTIs) and potential damage to the urethra.'   

I get that to a point. Giving every Tom, Dick and Harry access to them over the counter would be inviting trouble. People would be bringing them to house parties just for the craic. Kids would be getting grownups to buy them a ten pack or a couple of singles for behind the shed with their mates, and doctor's surgeries and hospital emergency departments would be filled with idiots arriving with one dangling from their cock or fully shoved up into their bladder! 😝

How good would it be though if catheter dispensers were available in pub corridors, cafes and train stations? I reckon that's a viable business start-up for some enterprising BPH sufferer.

Users do need to be instructed on their use as I was by nurse Cathy but you don't have to be a brain surgeon. It only took a few minutes with her before I was sent off with a box of 30 under my arm and fully qualified to use them any time I pissing well wanted!

There isn't much to it - 

1/ get cock out

2/ open catheter package

3/ stand over toilet bowl

4/ insert catheter end into pee hole

5/ push tube gently until it won't go any further

6/ direct the gushing pee into toilet bowl or urinal

7/ wait for pee to stop flowing

8/ remove catheter carefully

9/ shake cock and put away

10/ dispose of catheter

11/ wash hands and go on your way

Urinary infections are the other issue. A sterile catheter itself poses little risk of causing infection, but if it is inserted through an unclean urethral meatus (pee hole) the risk grows from bacteria being transferred up the urethra into the bladder on the tip of the catheter. In the 1.5 years of using catheters 4 or 5 times a day I had only 3 urinary tract infections so the risk is small.

Joking aside - the issue I have is that like me many men are not introduced to the idea or possibility of self-catheterisation early enough in their journey to painful urinary retention. During many visits to my doctor over a number of years he never once mentioned them as a possible stop-gap treatment. Some readers might say "Why didn't you think of it yourself!?" but what man comes up with his own idea of sticking a tube up his cock to help him pee? As I wrote earlier, the word 'catheter' isn't one you associate with your life. 

How many men are at this moment suffering needlessly from UR because they do not know about self-catheterisation? My guess is that it's in the millions. With over the counter availability, so much needless suffering could be avoided. Men who's UR prevents them from socialising or just getting out of the house could be freed from their affliction. They could confidently go to the cinema or the pub, for a walk or to their kid's sports match without worrying about whether they are going to be crippled with pain and/ or pee themselves.

A simple permission in the form of a credit card sized id card could allow this to happen. Present it to a chemist and make your purchase over the counter. In addition all doctors should be retrained or advised on the severity of the UR condition so that no suffering patient leaves their consultation in unnecessary pain.

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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.

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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.