Bladder leaks continuously after hip replacement surgery
DEAR DR. ROACH: I am a male, 83, and my bladder leaks continuously since I had a hip replacement surgery. The surgeon used a catheter during the surgery, and when it was first removed, I could not urinate. I went home with a new Foley catheter. Five days later, it was removed, and I have dripped ever since. It has been over two months since the surgery, and the leakage has not abated. I typically use absorbent underpants and pads that I must change four times a day. I also urinate 100-300 milliliters several times during the day and at night.
This is my third joint replacement in the past four years, and nothing like this happened in the previous two surgeries, or in earlier surgeries I have had. What might have happened, and what are my options other than an inserted catheter worn constantly? I have not seen this problem addressed in your column, which I faithfully read. -- W.A.M.
ANSWER: Inability to urinate after surgery is common, especially in men. However, I am concerned that the Foley catheter itself may have caused additional complications. Urine infection, bladder spasm and bladder contracture all are complications of having a catheter. Damage to a nerve during surgery is possible as well.
You should have seen a urologist two months ago, when this started, and it is urgent that you get in to see one now. The urologist will evaluate for these possibilities. A long-term indwelling catheter is probably not your best option.
DEAR DR. ROACH: I get severe nerve pain in my calf area due to diabetes. I saw an ad for Lyrica on TV and found that its generic medicine, called pregabalin, is available now. I requested my primary doctor prescribe it for me. But he declined, saying that it is in the category of opioids and cannot be prescribed by him. Please let me know if this is true, that his license has restrictions on prescribing such medicines. If so, should I change my doctor? -- J.M.
ANSWER: Pregabalin (Lyrica) is not an opioid. It works on a different receptor, called the GABA receptor, similar to how drugs like diazepam (Valium) work. However, it is a controlled substance, although it is classified as having the lowest risk for abuse potential. Some physicians do not have the ability to prescribe controlled substances. They must apply to do so.
Both pregabalin and the closely related gabapentin (Neurontin) are effective treatments for diabetic neuropathy. They are not right for everybody, and there are alternatives that are not controlled substances, such as amitriptyline.
Rather than asking for a particular treatment, such as Lyrica, you might ask your primary doctor for what he thinks is the best treatment for your severe calf pain. He may wish to get additional information, choose a different treatment or refer you to an expert in treating nerve pain in people with diabetes.
DEAR DR. ROACH: After I wear my cloth mask, I spray it with disinfectant inside and out, and hang it up to dry for 24 hours instead of washing it every time. Do you think that's good enough? -- H.B.
ANSWER: I am sure the spray will disinfect the mask, but I would recommend against this method. The residual chemicals left on your mask after spraying are not good for you to breath in or to rub up against your face. Just washing your mask by hand with hot water and soap is fine.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.
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