When bladder doesn’t empty, urinary-tract infection is likely

DEAR DR. ROACH: I am a 70-year-old male. In 2013, I experienced an episode of total urinary retention. My urologist’s diagnosis was enlarged prostate and he tried treating me, unsuccessfully, with drugs, after which I underwent a TURP operation. Six months later, I experienced another episode of urinary retention, which resulted in a transurethral resection of the bladder neck operation. Between these two operations, I had two urinary tract infections.

A year after my initial surgery, I experienced another UTI, and frequent and weak-stream urination, so I switched to a new urologist. After examining me, he said that my bladder neck was almost completely blocked with scar tissue. He recommended and performed immediate surgery.

I have since relocated and have not experienced any more episodes of urinary retention. My urinary stream is good, and I am not on any medications (like Flomax, etc.) whatsoever. However, my new urologist is concerned because I continue to have UTIs — about two per year, with my most recent being in October. He thinks the UTIs are being caused because I can’t empty my bladder fully (a sonogram showed 250 millilitres left in the bladder after I urinate). My urologist put me on antibiotics and scheduled me for a followup visit, when he intends to perform a cystoscopy. I am concerned about where all this is leading. Despite having three operations, I still have sexual function and no incontinence. I do not want to go under the knife again and risk permanent, damaging side effects if I can avoid it. So I am seeking your opinion as to how to resolve these recurring UTIs. — Anon.

ANSWER: After urinating, the bladder should be very nearly empty — less than 12 millilitres. With 250 millilitres left in the bladder, urine infections are going to be almost impossible to prevent. Since the urine stays in the bladder, any bacteria that gets in can grow, and won’t be removed from the bladder when you void.

I do understand your desire to avoid further operations, but I have to agree with your urologist that you might benefit from it if you continue to have so much urine left in the bladder. The risk for developing sexual dysfunction with this kind of operation (presumably, a revision of the bladder neck surgery) is small; however, there is a risk of incontinence, which must be balanced against the benefits.

If after the cystoscopy your urologist feels that the benefits outweigh the risks, I would take that very seriously.