Follow
Share

I am his medical and durable POA. He is retaining 1500cc of urine in his bladder after voiding, and it will soon cause kidney damage. He is "with it" enough to understand this but he finds the indweling catheter intolerable and threatened to pull it out when he had one placed, and stated "it is better just to die than wear this".

So I went back to the hospital and had the nurse deflate the balloon and remove it properly, and she told me to get medical POA (which I already have). I am wondering about this nurse's comment: even though I can legally enforce that he wear a catheter, he may do some serious physical damage pulling it back out again if he doesn't want to wear it. And guardianship is obviously not an option because he is competent although moderately demented. He is living in a locked memory care unit with a 24/7 charge nurse so catheter maintenance is not at issue here.

More details: This catheter is meant to be worn only one month while the urologist assesses if he is a candidate for surgery (cystometrogram, cystoscopy, kidney imaging) and to prevent kidney damage.

This blockage is caused by prostate enlargement (BPH) which has been medically treated with 5mg finasteride and 2 flomax for 3 months to no avail. He was diagnosed with BPH years ago and was taking 1 flomax daily the whole time. This is probably more detail than anyone wants to read but just in case anyone is thinking there it can be medically treated.

So the family doctor was following the BPH for years. My Dad finally complained of bedwetting (really out of character for him because he is embarrassed by it) so I immediately took him in for a workup and he got referred out to a urologist.

This question has been closed for answers. Ask a New Question.

16 Answers

Most
Helpful Newest
First Oldest
First
Ask about a Transurethral Urethral Resection of the Prostate (TURP), which can be done under local anesthesia with a sedative. If you can avoid general anesthesia, there is less risk to the patient.
Nobody wants to wear a catheter all the time, but would he be willing to have one inserted and removed every 6 hours? Could he do this himself with a reminder from the nurse? For example: 6am, noon, 6pm and midnight?
Helpful Answer (0)
Report
He is not willing to have a catheter period. This catheter was only meant to be for 1 month. (I say "only" but I know that indwelling catheters must be uncomfortable; it's just to clarify that it is not and was never meant to be permanent). He would not be willing to have a catheter inserted and removed every 6 hrs. I can tell you that with certainty.

Reminders are not an issue as he is in a locked memory care facility with 24/7 nursing staff; the issue is that he absolutely refuses the catheter.

Basically, I am worried because apparently without it the surgeon will not be able to even assess his bladder function and his candidacy for TURP. The surgeon is not going to perform a TURP if his bladder is not functioning well enough on its own. So I am thinking, the surgeon is not going to perform a TURP if my Dad absolutely refuses any catheterization with retention this pronounced.

Clearly, any procedure is risky in a 84-yr old even with local anesthesia, so add to that noncompliance and no assessment of bladder function. I don't think TURP is going to happen.
Helpful Answer (0)
Report
I'm not sure exactly what that will do. Couldn't he still pull out his catheter at the first opportunity, even if I can legally have it replaced?
Helpful Answer (0)
Report
A urethal catheter is very hard to pull out because there is outer layer to it that has a balloon that retains it in the neck of the bladder. My husband was told that the alternative to the TURP was a suprapubic where they remove the prostate from the outside rather than the inside, which is more drastic surgery. We did have one horrible night when he wound up at the ER with a totally closed uretha which is very very painful. Kidney damage is a slower, long-range problem, but a total blockage is an immediate and painful emergency. It does help the patient be more willing to go along with some sort of treatment!.
Helpful Answer (0)
Report
OK this is good to know, that it's hard to pull out. But I have heard pts pulling out their catheters and my Dad would definitely try. Also, I am a bit worried about my Dad "firing" me as his POA, which would be a disaster, although he tends to place total trust in me...he is very verbal and intelligent and will start requesting a lawyer etc.
Helpful Answer (0)
Report
My Dad's also been known to exit a moving car when not getting his way so the drive home from the urologist's would be...interesting.
Helpful Answer (0)
Report
Jem I don't quite understand why the bladder function has to be assessed before a prostatectomy can be performed. There is now a lazer proceedure that basically vaporizes the prostate from the inside using a cystoscope. Ask the urologist if he is a candidate for a green light lazer proceedure. The recover is very fast and he could go home same day or next morning. He would probably only need the catheter till he is discharged. There may be some discomfort urinating and leakage for some time after any of these proceedure. Light anesthesia only and far less risk to the general health of an 84 year old.
he definitely would be able to pull out a foley if he puts his mind to it. It might hurt but it still can be done with a good tug. he may even figure out that if he cuts the end off the little side tube he can drain the water out of the balloon then it's easy to get out. Would Dad accept a supra pubic catheter.. A small incision is made just above the pubic bone and a catheter inserted into the bladder where it remains permanently. A supra pubic catheter could be put in without anything else being done. I would not try to enforce any treatment against Dad's will. it really isn't worth it. hope all this works out for you and Dad. Let us know what happens.
Helpful Answer (0)
Report
Veronica91 I hope you are right. I am hoping my Dad can get some kind of procedure done without a complete workup. Certainly a suprapubic catheter would be a possible alternative if surgery is not an option, however I would think that would only be considered as a permanent or longterm solution, not just for a workup. I will be talking with the surgeon next week.

My Dad like I said does have memory problems BUT he is extremely intelligent. He knows more than average. He will remove the bag, cut the catheter, yank on the thing, and complain loudly to the point that he will get transferred to a SFN, even if he can't pull it out.

Just out of curiosity I read up on Guardianship in California and even for a temporary emergency order you have to file a full petition for "Conservatorship of the Person" (aka guardianship in other states) and the conservatee has to attend the court proceedings. Only lasts 30 days with no extension. Yeah, probably not going to be the most expeditious way to get things done.
Helpful Answer (0)
Report
*SNF
Helpful Answer (0)
Report
jem you are correct the supra pubic would be a permanent solution. do you think dad would accept that. depending on his general health that could be the best solution and the least dangerous for him. there is still the danger of infection but with skilled nursing care available the risk is probably ledd that self cathing several times a day which you said he would never consider. I would continue to allow him to make his own decisions anything you try to inforce will only make him uncooperative.if he says he'd rather die that have a catheter so be it but it won't be a pleasant death. Anyway see what the sugeon recommends then do your own research on the options presented.
Helpful Answer (0)
Report
See All Answers
This question has been closed for answers. Ask a New Question.

Recent Questions


Popular Questions


Related Questions

Ask a Question
Subscribe to
Our Newsletter