ok… time to get down to serious issues – like catheters 😉 If you've never had a first-hand experience, you may want to pay close attention (or not!). If, as in my case, you have a catheter inserted as part of a surgical procedure, the chances are very good, that you wake up to find everything already "in place", so you've missed the thrill of having one inserted while conscious – which is truly something to be thankful for.
now, depending on the reason, you may have one of these to play with for a very brief period… or for something like prostate surgery you may have one as a pet for 2 weeks or more – in which case (as we'll discuss further, later) you'll grow very attached to it – quite literally!
the premise is quite simple – even if you're toes start to curl up, just at the thought – a tube ranging from 3 to 10 mm in diameter is inserted thru the end of your penis up the urethra into your bladder so urine can drain, hopefully unimpeded out and into an initially sterile bag, so that it's colour and volume can be closely monitored – as there seems to be an overwhelming occupation with such things following various surgeries – especially a radical prostatectomy.
the end of the tube is held in place in the bladder by a small water filled balloon – inflated AFTER the tubing is inserted… as the tube is essentially composed of 2 separate passages – one used to inflate and deflate (BEFORE removal) the balloon with water and the other to drain urine…
while in hospital, the entire process of monitoring output and emptying or changing bags is handled by your nursing team… if you leave with one in place, all that fun becomes your responsibility. And once you leave the hospital, you have the added logistical nightmare of exactly what to do with that 30 ft. of tubing and the 2 litre bag of urine while you travel around. The most common and I assume the most aesthetically pleasing method, is to wear the bag attached to your lower leg – hopefully hidden under your pant leg (not the time to wear shorts – regardless of the season or outdoor temp). Now this would have been a most appropriate solution back in the 70's when my bell-bottoms could have hidden a 4 litre catheter bag, 2 cats, a quart of Southern Comfort and my younger brother. Even 13 years ago, it was possible to almost disguise a 2 litre bag under a pant leg. But, today – I have no idea how this would work, given the trend to ultra skinny pants – let alone the cropped or rolled styles that go with… you can't even fit your legs in there without shaving them first, so there's no way to hide 2 litres of urine in there – although given today's fashion sense, I suspect wearing the bag on the outside of the pant leg would fit right in – at least under the umbrella of "business casual" 😉
and I guess that's enough about the "joy of catheterization" except for the removal, which will indeed be held until the next post.
however, I still want to explain WHY catheterization is so necessary in the case of radical prostatectomy surgery. As mentioned earlier this month, my comprehension of the male anatomy prior to being diagnosed with prostate cancer, was sadly lacking in this particular area. The other major system employed for emptying things, I was unfortunately very familiar with – given my chronic IBS and the frequent scopes and other investigative procedures that this had necessitated ever since I was in my teens.
but, now I had come to learn not only the role the prostate plays, but exactly where it is situated (when present) and what the impact of having it removed would be (physically, emotionally and psychologically) – only the first being considered here and now.
the prostate sits just between the base of the penis and the bladder, with the urethra running thru it… typically a healthy prostate being about the size of a walnut and 3-4 cm in length and consequently the prostatic urethra (that portion running thru the prostate gland) being similarly 3-4 cm (or 1.2 – 1.5 inches) in length. Now when removing the prostate, that portion of the urethra is naturally removed along with it shortening the total length by that amount – and the remaining end being reconnected (sewn) to the bladder.
now, the male urethra is very elastic (it's fairly obvious, if you give yourself a minute to think!) and being able to stretch it to the bladder to make up for the lost inch and a half, is no problem. However, because this "resection of the urethra" needs time to heal, it is considered necessary to have a catheter in place to protect this newly stitched joint. so, now you know WHY we need a catheter following a radical prostatectomy.
the impact of that missing 1.5 inches of very elastic urethra is a story for another day…