Health
Bladder leakage after total hip arthroplasty
Dear Dr. Roach: I’m an 83 year old man and my bladder has been leaking since I had a hip arthroplasty. The surgeon used a catheter during surgery, but was unable to urinate when the catheter was first removed. I went home with a new Foley catheter. Five days later it was removed and since then I have dripping. More than two months have passed since the surgery, and the leak has not diminished. I usually use absorbent pants and pads, which need to be changed 4 times a day. Also, urinate 100-300 ml several times during the day and at night.
This is my third joint replacement in the last four years and nothing like this has happened in the previous two or previous surgeries. What happened? What are your options other than always wearing an inserted catheter? I’ve never seen this issue addressed in your column that I read faithfully.
— — Wham
Dear WAM: Men, especially men, often cannot urinate after surgery. However, I am worried that the Foley catheter itself may have caused further complications. Urethral infections, bladder spasms, and bladder contractures are all complications of using a catheter. Nerve damage during surgery is also possible.
I should have seen a urologist two months before this started, so it’s urgent to see him now. Urologists assess these possibilities. Long-term indwelling catheters are probably not your best option.
Dear Dr. Roach: Due to diabetes, there is severe nerve pain in the calf area. When I watched an ad for Lyrica on TV, I found that a generic drug called pregabalin is currently available. I had my doctor prescribe it. But he declined, saying it was in the opioid category and could not be prescribed by him. Please let us know if this is true and that his license has restrictions on prescribing such drugs. If so, should I change my doctor?
— — JM
Dear JM: Pregabalin (lyrica) is not an opioid. Similar to how drugs like diazepam (barium) work, they work with another receptor called the GABA receptor. However, although classified as the least likely to be abused, it is a controlled drug. Some doctors do not have the ability to prescribe controlled drugs. They have to apply to do so.
Both gabapentin (neurontin), which is closely related to pregabalin, are effective treatments for diabetic neuropathy. They are not suitable for everyone and there are non-regulated alternatives such as amitriptyline.
Instead of seeking a specific treatment, such as Lyrica, you can ask your doctor what is the best treatment for severe calf pain. He may want to get additional information, choose another treatment, or refer him to a specialist in the treatment of neuralgia in diabetics.
Dear Dr. Roach: After wearing the cloth mask, spray the disinfectant inside and outside and hang it for 24 hours to dry instead of washing it every time. Do you think that’s enough?
— — HB
Dear HB: I’m sure the mask will be disinfected with a spray, but I don’t recommend this method. The chemicals left on the mask after spraying are not suitable for inhaling or rubbing on the face. All you have to do is wash the mask with hot water and soap by hand.
Readers can email their questions to [email protected].
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