Catheterization helps protect kidneys

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.

T.L.

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.