Urinary retention ensues due to anesthesia coupled with BPH

Dear Dr. Roach: Iaman 80-year-old male. I have had benign prostatic hyperplasia (BPH) for more than 20 years, and it is getting progressively worse. I had urinary retention after my ankle surgery in 2019 and had to go to the emergency room to get catheterized. I was lucky that the ER doctor made the correct diagnosis at that time of night.

I found out later from my urologist that the anesthesia given prior to my surgery, coupled with my BPH, caused urinary retention. He suggested shrinking my prostate. Otherwise, if I take anesthesia before any other procedure, this will happen again. I was advised to get anesthesia for my broken tooth back in 2022, but I am putting it off.

My question is, if I’m unconscious before an emergency procedure, what can be done to prevent urinary retention? — S.G.

Dear S.G.: Because the urethra (the tube that carries urine) runs right through the prostate in men, enlargement in the prostate can slow and even completely stop urinary flow, causing the condition known as urinary retention. Some of the medicines given in a surgical procedure can precipitate urinary retention.

In an emergency situation, doctors will place a catheter directly into the bladder, allowing the kidneys to drain and preventing kidney damage that could potentially be permanent. Placement of a catheter can sometimes worsen swelling for a time. Many male patients of mine have had to go home with a urinary catheter in your situation.

If you aren’t ready for a surgical procedure, then medications are an option. Alpha blockers like tamsulosin (Flomax) shrink the prostate within hours, while a different class of medicine shrinks the prostate over months. I have many men on both types of medicine. Starting medication now might prevent a future crisis.

Dear Dr. Roach: I am 81 and in good health, except for the aches and pains that are common at my age. I also have fibromyalgia. Several years ago, I saw a suggestion about using turmeric for reducing inflammation and pain. My doctor approved, and I tried it. It worked well, and I was delighted.

However, my new doctor says that I shouldn’t take turmeric because it is an NSAID, and he never believes in giving a person my age an NSAID because it might affect my kidneys.

Is turmeric really an NSAID? I’d sure like to know because this will affect the quality of my life. — Anon.

Dear Anon.: NSAIDs, like ibuprofen or naproxen, work by blocking an enzyme called cyclooxygenase, which prevents the body from making inflammatory compounds such as prostaglandins and thromboxanes. Although this reduces pain and swelling, there are unwanted effects as well. There are prostaglandins in the kidney that protect the kidney under times of stress. NSAIDs remove this protection and make kidney damage more likely. There are also other possible mechanisms of injury with NSAIDs.

Curcumin is the principal active compound in turmeric and, along with its active metabolites, has completely different mechanisms of action. I’m afraid that your new doctor was wrong. Turmeric is not an NSAID.

As far as its safety with the kidneys, there are two potentials for harm: The first is that turmeric can predispose people to kidney stones, although this isn’t a likely outcome. Secondly, turmeric can affect levels of some drugs, which can lead to toxicity in the liver and kidney.

However, the overall effect of turmeric on the kidneys appears to be safe, certainly safer than NSAIDs.

Dr. Keith Roach