My dh suffers from a very enlarged prostate that is cutting off his ability to pass urine through the urethra; he has had a catheter for about a month now. We spoke to his Urologist today about a TURP procedure to create a channel for his urine to pass. Under normal circumstances this procedure is a "piece of cake"; however, Herb's bladder is damaged from holding on to all of that urine for "who-knows-how-long" and the procedure is not a "sure thing" now. 50/50. However, if it doesn't work, we're back to the catheter (no change from the way it is now). If successful, he should be able to pee on his own ... if he remembers how to do it.
What I'd like to know from you veterans out there is if this procedure (at best) is really worth the pain and effort. Will dh eventually lose the ability to control his bladder anyway? What's more of a hassle for me the caregiver, a catheter or constantly having to change adult diapers and change linens soaked with urine in the middle of the night? I confess, this is really all about me. I'm sick and tired of dealing with the catheter; but, will the diapers that are to come be even more of a problem than dealing with emptying and changing a catheter for the rest of his life? Since draining his over-burdened bladder and giving him 2 units of blood last month, he's back to his old, chipper self. His memory sucks, but everything else seems to be back. I don't think the Lord is going to be claiming him anytime soon ( he was so sick before, I thought his last days were upon us).
I would really appreciate input from those of you who have undergone the onslaught of incontinence. When, in the progression of this disease does that problem occur? Is it inevitable that it will occur? I just don't want to put dh through this invasive procedure if the reward isn't enough to warrant it.
I don't have any experience with the specific question you're asking, but if it were me, I would opt to keep the catheter. I think his age would be part of the equation, too. My reasoning it that any surgery is going to be hard on him. 50/50 are not good odds, in my book, for the surgery to done. In addition, if his bladder is damaged, I think he would be more likely to be incontinent. I have been fortunate to have had (mostly) good doctors that I could trust and found that if I told them exactly as it was with me, they helped me make a decision that ultimately I was comfortable with. What ever decision you make, the best of luck.
mothert--my advice would be to get another opinion from a neuro or geriatrician. There are a lot of factors to consider. My husband had a TURP before his dx and it improved the situation for a few years, but then the urologist put him on medication for his enlarged prostate (after dx) and it exacerbated the dementia symptoms and threw him into delirium. His neuro then told me ALL meds for enlarged prostate are not recommended for a dementia patient.
As far as the catheter--I wonder how cooperative your husband will be in the future with this. I know that when mine reached the middle stages, he became uncooperative with toileting issues, which were much less invasive than trying to deal with a catheter. As far as when incontinence strikes, you may want to check the stages of the disease on the Fisher Center site, and compare with where your husband is now . Generally, I think most people with dementia experience urinary incontinence at some point.
mothert its hard to know the outcome especially with the medical issues involving the bladder as is. I do know the recovery of the turp procedure is going to be tuff for one with dementia. at this point your choices, cath or diapers either isn't ideal. but for me eventually he will probably have more bladder issues with retention and utis from what you are describing. if it were me I would also opt for catheters vs surgery that is iffy at best. and he will probably be somewhat incontinent even if he has the surgery as the dripping was what turned me against having the procedure for my own DH. dealing with diapers isn't so very bad once you get the hang of it friend. I know the idea of incontinence is quite overwhelming at first but those of us who know the ropes will tell you yes at first but you do get quite adept at management and care. to me, that is much easier than dealing with shadowing and aggression times. we all have our bridges to cross during this journey, yours may not get as worrisome as you are thinking, and it may be easier than expected. go with your instincts and then make good on your decisions without guilt or rehashing your thoughts. it will all work out one way or another. divvi
One thing (BIG THING) that I failed to mention in above post is that dh's prostate has completely cut off his ability to urinate on his own. The urine stretched out his bladder significantly and the urine backed up into his kidneys putting him into kidney failure. So, something has to be done to enable him to get rid of his urine. I do believe he will become very difficult with the catheter as time passes AND that he will also become incontinent at some point. If this procedure fails, he will be stuck with the catheter, period.
I don't understand all your hubby medical issues but if the prostate is block off his ability to urine what about removing the prostate? Would that help?
I am wondering the very same thing. I will have to discuss this with his doctor. Because of his dementia, the plan is to do a spinal block and not knock him out with anesthesia. The prostate surgery is longer and I don't know what the options are for anesthesia.
My DH had the TURP Procedure, he recovered and was able to go to the bathroom with no trouble, although he often had accidents when he didn't get there in time, or during the night. I'd talk it over with the doctor and follow his suggestion.
T, my heart goes out to you! No easy answer. I can't tell you what I would do as I have learned the hard way it is easier to say what you think you will do if it ever happens to you, and a completely different matter when you are actually dealing with it head on. I am however a firm believer in second opinions, by a specialist. Keeping you in my thoughts as you face these hard decisions ((Hugs))
Thank you all for your advice. I have emailed dh's neuro, who we will be seeing just a few days before his scheduled procedure, and asked him about possible problems with this surgery - haven't gotten a reply yet, probably tomorrow.
Nikki, a second opinion is a very good idea, I will be seeing our PCP on Friday for me (I'm falling apart - I'm sure nothing like that ever happens to any other caregiver
My hb had the TURP procedure and had no problems albeit he hadn't had the severe problems your hb has. Later in the dementia journey, he was incontinent, but that wasn't a health issue as the prostate-caused blockage had been.
My husband had two TURP procedures and they did no good. He has Atypical Parkinson's, and the more significant problem is that the bladder muscles are not properly coordinated. The urologist strongly recommends intermittent catheterization, which my husband is willing to do himself, though not as often as he should. But the next step is a suprapubic catheter, which comes out the lower abdomen rather than the penis. It still has to be changed once a month and it can make infections more frequent. But it is much more comfortable than the Foley catheter inserted through the penis.
What I really hate about the catheter is that it absolutely ties me to him. I empty it, I change the drainage bag from morning to night and back again. It isn't a difficult task, just time consuming and he can't do it himself so we have to go to bed at the same time (although I have to sterilize the bag I just removed before I can hop into bed) and I have to get him up and dressed in the morning, which effectively kills my morning activities. It all but kills any opportunity for a overnight getaway with friends. So, I'm going to try the TURP and pray that it works. If it doesn't, then we're just stuck with the catheter forever, I guess. This seems to be a common problem for men his age.