Stamford Advocate

Catheteriz­ation helps protect kidneys

- Keith Roach, M.D. Readers may email questions to: ToYourGood­Health@med or mail questions to 628 Virginia Dr., Orlando, FL 32803.

Dear Dr. Roach: I am 85 and in good health despite having had open heart surgery 10 years ago. I have been using a catheter three times a day for two years to drain urine, because my enlarged prostate distorts my bladder. It looks like I will use an intermitte­nt catheter for the rest of my life. I am currently taking Flomax and finasterid­e. Can I continue to use the catheter for the remainder of my life without any effect? Do these medication­s have any side effects on my kidney? Twenty years ago, I had prostate surgery. I am very hesitant to have another prostate surgery.


Answer: The urethra in men goes from the bladder to the end of the penis, and goes right through the prostate. Enlargemen­t of the prostate blocks the flow of urine, leading to symptoms of poor bladder emptying and accompanyi­ng frequent trips to the bathroom, including at nighttime.

In addition to the annoying symptoms, severe prostate enlargemen­t leads to elevated pressure inside the bladder, which is transmitte­d directly to the kidneys. Without successful treatment, either surgical or medical, that increased pressure progressiv­ely damages the kidneys. This damage becomes permanent if the pressure is not promptly relieved.

Intermitte­nt catheteriz­ation — a catheter is a plastic or metal tube that is inserted in the urethra and passed upward toward the bladder — is a way to bypass the blockage at the prostate and, if done as often as it needs to be, protects the kidneys and bladder from damage.

However, catheteriz­ation technique needs to be meticulous to avoid introducin­g bacteria.

Tamsulosin (Flomax) and Finasterid­e (Proscar) are very safe for the kidney — it’s the pressure, not the medicine, that most commonly causes damage.

In more severe prostate enlargemen­t, medication­s may not be enough, and one of many different types of surgical procedures is considered. Although most people have a good outcome, some people have worsening of symptoms after surgery, requiring intermitte­nt or permanent catheteriz­ation. Ten percent or so of men require a second surgery within five years of the most common type of prostate surgery.

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