Catheterization May Help Protect Kidneys | News, Sports, Jobs

DEAR DR. ROACH: I’m 85 years old and healthy despite having open heart surgery 10 years ago. I have been using a catheter three times a day for the past two years to drain urine because my enlarged prostate is distorting my bladder. It looks like I will be using an intermittent catheter for the rest of my life. I am currently taking Flomax and Finasteride, but it really seems to help me. Can I continue to use the catheter for the rest of my life without any effect? Do these drugs have any side effects on my kidney? Twenty years ago I had prostate surgery, with my urologist using microwaves to burn and open the prostate canal. I am very reluctant to have another prostate operation. – TL

ANSWER: The urethra in men goes from the bladder to the end of the penis and passes through the prostate. An enlarged prostate blocks the flow of urine, causing symptoms of poor bladder emptying and accompanying frequent bathroom use, including at night.

In addition to bothersome symptoms, a severe enlarged prostate causes high pressure inside the bladder, which is transmitted directly to the kidneys. Without effective treatment, whether surgical or medical, this increased pressure gradually damages the kidneys. This damage becomes permanent if the pressure is not quickly released.

Intermittent catheterization – a catheter is a plastic or metal tube that is inserted into the urethra and passed upward to the bladder – is a way to get around prostate blockage and, if done as often as necessary, protects kidneys and bladder from damage. However, the catheterization technique must be meticulous to avoid the introduction of bacteria.

Tamsulosin (Flomax) and similar drugs work on the small muscles of the prostate and may relieve symptoms of a mild enlarged prostate very well.

Finasteride (Proscar) and similar drugs work by blocking a type of testosterone. Over the months, it shrinks the size of the prostate. These drugs are very safe for the kidneys – it is the pressure, not the drug, that most often causes damage.

For more severe enlarged prostate, medication may not be enough and one of many types of surgeries is considered. Although most people have a good result, some people have worsening symptoms after surgery, requiring intermittent or permanent catheterization. About ten percent of men need a second surgery within five years of the most common type of prostate surgery. Microwave therapy has a much higher risk of requiring reoperation than traditional surgeries or some newer options.

DEAR DR. GARDON: For the past few years, I have had pain and numbness in the first two fingers and the thumbs of both hands. I told my doctors about it and got no response. Lately the same is starting on the last two fingers of my right hand. I have been diabetic for over 20 years. – JK

ANSWER: The localization in the hands is strongly suggestive of carpal tunnel syndrome. Many people also notice that part of the ring finger may also feel pain or numbness. Diabetes is a known risk factor for developing carpal tunnel syndrome.

A physical exam can often make the diagnosis with reasonable accuracy. A nerve test (EMG and nerve conduction test) may be needed if the diagnosis is uncertain or if surgery is being considered. For mild cases, conservative treatment with anti-inflammatory drugs, a wrist splint, or an injection may be effective. If hand strength is affected or non-surgical treatment is ineffective, then surgery may be considered.

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