Catheter in or out?

Carelotsss: This is a question for a medical doctor and shouldn't be left for a caregiver to answer. Perhaps you should also be in contact with your father's neurologist.

I’m not a nurse or Dr. My dad has had a catheter for the past 15 months, suddenly unable to pee following hernia surgery repair. He improved minimally to being able to pee a few oz during a trial, but unable to empty enough. I’m interested in trying the flip-flop valve someone mentioned. I would recommend, let his bladder make the decision so you don’t have to. In other words, schedule 2 urology office visits - one in the morning and on in the mid-late afternoon of the same day. Have them remove the catheter in the morning; take him home and have him drink at least 32 oz water throughout the day and try to pee intermittently (collect it in a beaker and record the ounces). Take him back for his later appointment and give report; they’ll have him try to pee some more, and will do an ultrasound of the bladder to determine if he is emptying his bladder or not. If not, they can replace the catheter.

You are collecting some great experiential information here. I can’t offer that but what is glaring to me is that you don’t have a better understanding of your fathers situation. You can’t make a decision without a good full understanding of the pluses and minuses and it is the doctors job to help you understand them and make a decision. If you ask he should make a recommendation. There often comes a point where a physician isn’t sure what’s best for their patient, treatment or discontinuing treatment because medically either route is the rite one but they don’t know the patient and their family well enough to know what’s rite in this case. Not all doctors recognize these junctures or say so but the caring ones do. I think you need a second opinion from a urologist and don’t be shy about asking the questions you need to both get a good feel for the new urologist (you are sort of interviewing them) and have a clear picture on the options and reason for doing or not doing them. Wrap up by asking what they would do if it were their father. Remember it isn’t their father it’s yours and no one knows him the way you do but a good caring doctor will say either of these choices are ones I support and this is what I would choose for my dad for this reason or will say this is what I would do because it’s really the option he or she believes is best. While ultimately the decision is yours as it should be his medical team should be making the choices clearer and it doesn’t sound like this doctor is doing that. You also might consult his primary if they know him well and you have a strong relationship with them, faith in them.

This stuff is never easy but his medical team needs to be making it as easy as possible in my opinion and that doesn’t seem to be happening. Write all the info down and write your questions down so you can refer to it all when speaking with a doctor because it can all go out the window when meeting with them, especially if they are skilled at not spending too much time explaining things to patients and their families. Funny aside, surgeons are notorious for not having good bedside skills so it has become popular, at least in our area, for every surgeon to have a communication person, at least these doctors see the importance and what they are lacking so the importance of having someone who acts as an arm of them to do the real patient contact. Maybe more doctors should have this!

“….after a stroke….” may mean the disruption of the neurological processes necessary to accomplish basic physiological functions. He may be “able” to pee, or not.

If you haven’t had a reasonably comprehensive rundown of his overall condition, incorporating as many of the specialists who have seen him as possible, it might be helpful to you (and to him), to request one now.

You should not be expected to make decisions of this magnitude without fully understanding causes and consequences of what you’re dealing with.

Make a list of his doctors and start firmly but politely requesting answers.

We have all felt “anxious and confused”, believe me, but “knowledge is power”. Your concern and love for him is evident. He is fortunate to have you.

Of course you don't know what's best. Your father's urologist is not communicating well with you to say the very least of it.

I second Alva's point that the urologist can't know what's best, either, not without trying the options and seeing. But to tell you you can "try it if you like" is... I don't know what to call it. A complete abdication of the doctor's role, it seems to me.

There are advantages and disadvantages to an indwelling catheter. There are risks and benefits to your father of getting rid of it. It's a matter of weighing everything up and deciding on a course of action; and it's the urologist's job as the clinician, holding and understanding the information required, to help you do that on your father's behalf and in your father's best interests.

Obviously! - you'd have thought, anyway.

Let's assume it is desirable for your father to regain full bladder function. Is that a realistic possibility? Yes/no. Yes doesn't mean it's definitely so, but no - if that's the clinical opinion, and there is a known risk of urinary retention - would rule out getting rid of the catheter; and in that case the management strategy needs to switch to reducing the risks and disadvantages of permanent catheterisation (mainly infection) as far as possible.

But let's say yes, it is realistic. In that case, one step for someone who has already been catheterised for substantial periods would often be a Flip-Flo. This is a kind of catheter aimed at retraining the bladder. At night it is connected to a night bag, but during the day the valve is closed, the bladder fills, and the person "pees" by opening the catheter valve over the toilet when he feels the need to go. Once this is happening on something like a normal toileting schedule, there is then a trial without catheter - the catheter is removed altogether and we wait to see what happens. Where we live the District Nurses would be on standby ready to recatheterise if the person can't pee normally, and there would be a stock of continence care products in case the person isn't fully in control (which might continue to improve over time); and I imagine there will be a similar service which I would certainly expect your urologist to arrange. If that's not too naive of me. But maybe it is! Is your PCP any more helpful?

Requires Medicaid-licensed facility placement since his required care is beyond your level of care. Your father pays for his own care. When his money nearly runs out, it's time to see an eldecare attorney for Medicaid eligibility. Apply at least 3 months before his money runs out that pays for his care. And, please do not expect inheritance.

I think the catheter thing has been covered so I am going to talk bladder.

Your profile says Dad has Dementia/ALZ. I would not have him operated on for bladder cancer. Both my parents had it and both did well with the chemo but someone with Dementia may not. Dads was caught early, so he went thru chemo. The chemo they use has TB in it. That means every time Dad went to the bathroom, the toilet and sink needed to be disinfected. They only had one bath. The chemo is put directly into the bladder, and you have to turn yourself every 15 min. Back, to side, to stomach, then other side. Mom, her bladder cancer was found in the tube from the bladder to her kidneys. So a small portion of the bladder was taken, the tube and her kidney. She then went thru the same chemo treatment Dad did.

I have a friend whose cancer broke thru the lining of his bladder and spread. He now has no bladder and uses a Urostomy pouch for the rest of his life.

My Mom had Dementia and her Urologist was still doing scopes passed the 5 yrs. I stopped them. If she got cancer again, we would have done nothing about it.

Are you comfortable learning to do a daily self-cath for your dad, or could he assist? This would allow him to use a single-use catheter as needed and get better information about what his body can do independently.

My dad couldn't do the self-cath by himself, and he had other issues preventing urination. But in your case, it might be worth looking into as a week or month-long experiment, so you can get better info for the doctors and also see where your dad is at with this.

You can find out how to remove a catheter on YouTube. I discovered that when my granddaughter several years ago was sent home after a procedure with a catheter. My daughter and I watched the video and took it out.
My granddaughter again just recently after having to have her appendix out was sent home with a catheter in and after a week my daughter just took it out herself.
You shouldn't have to stress over this, so just have the nurse take it out next time she comes and if for some reason he doesn't start to pee on his own after many hours you can have him brought to the ER(if it's overnight)or to his urologist in the morning.
And like already suggested if this is an ongoing issue please talk to his urologist about having a supra pubic catheter placed in him. My late husband had one for the last 2 years of his life, and it made my life so much easier.
Best wishes.

It always surprises people to learn that doctors don't KNOW what will happen. This doctor was at least honest with you. You are apparently the POA for your Dad and doctor has fully informed you why your Dad cannot in all likelihood empty his bladder.
You are also good diagnostician yourself! Yes, dependent on where this hernia is, it may pressure the bladder which would cause more incontinence, but not retention. And the retention, even of small amounts, is the problem. The patient will have frequent infections when unable to empty bladder adequately.
You have a history of being unsuccessful with removing indwelling catheter, and I am surprised they have not by not moved to a suprapubic permanent catheter for your Dad.
You apparently keep asking about removal and Doc has said "Sure, give it a try". If you want to try once more then I as an RN would say "Sure, give it a try if you like". BUT....................
In order to give this a good try you need to know the following. Give Dad a good chance. Be certain he stands or sits up to void, run water in a sink to give his body the "idea" to go. Encourage a deep deep breath in slowly and then letting it alllllllll outtttttt, slowly. This often releases the flow. Ask the RN who should (MUST!) be sent to support this attempt and ask her to teach you how to assess your Dad's bladder to know if he is retaining urine. He should be laying flat. The bladder is just above the pubic area and it should be flat. You will FEEL the growing bladder as it fills with urine and it is distended as a balloon when it is full. This is dangerous and the more it happens the more receptors will be destroyed and the more difficult for Dad to go.
Assess all meds. Look them up online. Type in their name along with "retention of urine" as in "atenolol and urine retention", and etc. Look up assessing the bladder for urine retention. Who knows, youtube may even have it as they have a lot on catheter care.
This old retired RN wishes she was next door to help you out with this try. Good luck.

I would call the urologist and get an appointment. Let them remove it and do an ultrasound. That way you know if he's retaining urine.