Insights on Bladder Health: My Unexpected Diagnosis

Yesterday afternoon I saw my surgeon for the final wound check on my gender affirming surgery of 31-Oct. Everything was good as far as that was concerned. I really wish that was the end of this update, but it’s not.

The surgeon is also my urologist, and took this opportunity to perform a test for voiding dysfunction. I didn’t pass the test. Warning: Mild medical TMI.

The test consisted of having me urinate (and catch a sample) before being seen by the doctor. I didn’t know, at this point, that the test was being done. I assumed I was just there for the wound check. After I did my business, the PA for this visit joined me in the room. He did the usual check-in routine (height, weight, blood pressure, medications review).

Then he mentioned that the doctor wanted to do an ultrasound of my bladder. That seemed a little odd. However, I had experienced that post-op issue with urinary retention. So, it could have been routine. And maybe it was up to that point.

That’s when things started to get interesting. While running the ultrasound over my lower abdomen, he asked me, “Did you empty your bladder after the urine sample?” I said that I had. And to my knowledge I had indeed done so. That was maybe 15 minutes earlier at this point. He said “There’s quite a bit still in there.”

He proceeded to tell me that the ultrasound measurement indicated that there was 543 ml of fluid in my bladder. Average bladder capacity is 400 – 500 ml for anyone over the age of about 12. So I actually had a somewhat over full bladder after just returning from the bathroom. And I couldn’t tell it. He didn’t tell me that about the average capacity at that point and I didn’t know.

He was done with his part of the visit. He told me the doctor would be in shortly to do the wound check. At this point, I still didn’t really know anything was happening other than a routine follow up visit. The surgeon came in, and she did the wound check. She was very happy with the healing. Even jokingly commented on how beautiful it was.

Then she asked if the PA had mentioned the volume from the ultrasound, and I told her what he said. She was quite surprised to say the least. She logged in to the computer and confirmed that I hadn’t misheard him. And then the nature of the conversation changed rather abruptly. All humor was gone from her tone. She became quite somber honestly.

Apparently, long term failure to fully empty your bladder can be really bad for one’s health. It can result in bladder stones, kidney damage, and incontinence, among various other issues. There are two main causes of this condition. Only one of them is treatable. BPH (Benign Prostatic Hyperplasia) is one of those two. I was diagnosed with that years ago, so it’s the leading contender in my case. It’s also the one that’s usually treatable. The other is weak bladder muscles (called atonic bladder). For that, the only management option is some form of long term catheter.

A couple of tests need to be performed. They will determine which is the cause of my issue. These tests will also show whether the standard treatment for BPH is viable for me. I am already scheduled for both tests. The first is on the 19th of this month, and the other was scheduled for 6-Jan. That second test is done by the surgeon in her office. She was scheduled to be out of office for the holiday weeks of Christmas and New Year’s Day. Therefore, the test was scheduled for her first day back.

As I was typing this, I got a call back from her office. She is not willing to wait that long, and is coming in on 23-Dec to perform that test. Her actions are backing up the urgency I picked up from her in the appointment yesterday. So, for Christmas, I get to find out what’s going to be done about my problem. A problem I didn’t even know I had. And one for which the cause is not yet determined, if certainly suspected.

Obviously, I’d prefer that it be determined that my case is from BPH, because that’s treatable. Now, to be clear, I am less than excited by the treatment option I would have. Anything is better than a long term catheter, though. And by long term, I mean permanent. The rest of my life.

So what is that treatment, you ask? Now we move beyond mild TMI to full on going there. The primary treatment option is something called transurethral resection of the prostate (TURP for short). It is a “minimally invasive” surgery to reduce the size of the prostate. This surgery allows increased flow of urine from the bladder. I quoted minimally invasive because, even though no incision is made, it feels really invasive to me.

The surgery involves placing a tool called a resectoscope into the urethra. The tool is then threaded up to the location of the prostate. It has a lens and some form of cutting mechanism. It’s usually an electrocautery device, but is sometimes a laser. I don’t know which my urologist would use. I’ll ask if we get that far. It’s not a minor surgery, even though no incisions are required. It results in a hospital stay of typically one to three nights. There’s more details about risks and recovery at the link above.

To be honest, I spent a good portion of last night crying. And I am crying again just trying to tell this to you, my reader. In the pagan community, we say that “The Goddess will never give you more than you can handle.” I want to know who told Her I was such a bad-ass, and would they consider taking it back? This last fourteen months or so have been a lot. I’m ready for a break from the drama.

In any case, the journey still continues. The next couple of weeks of suspense are going to be a struggle. But I will keep going forward, one step at a time. Even if, occasionally, it feels like two steps back to every one step forward.

Tags: BPH, medical tmi, spoonie, TURP, Urinary Dysfunction