Kidney related questions/comments for Dr. Sancha

Hi Dr. Sancha (and everyone else),

I think you know how much I respect you, and appreciate your efforts in the
ng. I have been debating whether to write this, since it will probably be
long and I'll start rambling, but you told me to go ahead, twice. I am not
a happy camper, and have stopped going to my uro's office (been in and out
of there 20 times in 2005 - mostly seeing the PA for massages and consults,
but also some visits to the MD who did my TURP last April - which
exacerbated my chronic prostatitis, which you may recall). I will be seeing
a new general surgeon Friday for my rectal problems.

I don't want to get repetitive and repeat all my medical problems, which are
sprinkled throughout the newsgroup, so I will try to address my questions
and comments mostly to the subject of urine production by the kidneys during
the day, versus at night. I like to use the English system for volume
measurements, but I will use metric, since that is what you go by. Please
remember I have been to many doctors in my life, so try to go easy on
getting another opinion out of town (which I have done several times in my
life for my various ailments - all to no avail), plus I live by myself and
don't have anyone to help me, except for one person. I only wish that some
of the many doctors I have been to were as kind and caring, and as
knowledgeable as you are.

I certainly know you can not diagnose me (legally or ethically) over the
Internet, and would never ask you to, like I mentioned to you once before.
If you could just provide your opinions, and comments, or suggestions (like
you are so good at doing in all your posts), I would appreciate it. Perhaps
I can get some piece of mind.

I had a TUIP in 1995 and the TURP last April (which was mainly to get rid of
the scar tissue caused by the TUIP). Both procedures were to increase my
urine flow, and decrease my retention, nocturia, urge, etc. I have a normal
size prostate, and a history of chronic non bacterial prostatitis (which I
call prostatitis/urethritis/cystitis - ie a continuum). I had bacterial
prostatitis in 1997, but my urine and expressed secretion tests under the
microscope throughout 2005, basically show WBC's, but no pus or bacteria.
Was on antibiotics much of 2005, little or no help.

It took me over 3 months to get over the TURP since it just exacerbated my
prostatitis, which I already had before the TURP. Anyway, the main reason I
am writing this is to try to understand why I can void during the day, but
not later in the day and at night (it is quite bothersome at night). I am
58 years old, a retired engineer, and live by myself, and lead a strange
life style compared to someone as active as you are. I go to bed late and
get up around noon time and have a light breakfast, and eat late at night
for my main meal. I don't think that is relevant, but I want to explain
exactly what is going on.

It took me a long time to void properly after the TURP and I was worried
about scar tissue or a stricture from the procedure. Anyway, If I drink a
lot after getting up, I can get a good flow, say from 2:00 PM to 8:00 PM. I
understand that if you don't drink much you are less likely to urinate :-),
but I believe this is much more complicated than that. I drink at least 2
liters of liquid per day and more likely 3 to 4 liters. But later in the
day, especially after my nightly meal which is around 9 to 10:00 PM, it
seems that my urine production stops (or my urethra is closing off for some
reason), and I have some theories on that.

I have measured my urine flow many times recently when I'm drinking a good
amount, and my flow is good. I have measured as high as 28 ml/sec average,
and usually around 23 ml/sec average. I'm sure you will say "that is good
Pete". So you would think that the TURP helped, and there is not a
permanent stricture or impedance. But later on in the day everything seems
to slow down and stop. I may be drinking less later on, but I don't think
that is the reason in itself. I can drink a 16 ounce glass of water with my
dinner at night, and I swear it never comes back out, plus my food has
liquid in it. If I go to the bathroom five times during the night, I would
say my total output is no more than 200 ml or so (ie 40 ml per voiding).
Like I say I just dribble, and have difficulty getting started. But yet I
remember filling the catheter night bag (the big bag for night time) when I
had my foley catheter after the TURP.

Also, it is interesting to note that one morning (afternoon for you all)
when I got up, I started making a bunch of phone calls, and never drank
anything and didn't get done till say three or four in the afternoon, and I
voided a fair amount. This is very interesting because I didn't drink
anything at all, and during the night I could not void good, like always.
So where did the urine come from after I got up, if I didn't drink anything.

One of my theories is that when I eat my dinner I am consuming salt (I do
not overdue it though and usually don't put salt on prepared foods with a
lot of sodium in them), and salt causes the body to retain fluid. But by
the same token food has liquid in it and you would think that may add to
urine production. Anyway do you think I am out in left field here, or is it
possible that the salt in my food is slowing down my urine production in
late evening and all night. I think I remember Ed saying once that pizza
can cause fluid retention.

My nights are miserable. I never sleep good - no talk of pills please - I
have taken every pill known to man :-) . I only catch catnaps and am up
every hour and a half to two hours going to the bathroom, but I just dribble
and can not get started, but remember I can pee like a race horse earlier in
the day. I don't think I am retaining, because when I do my "press on the
belly test" that I have done since I was a kid, it does not feel like I have
to go badly. But I do have a very aggravating urge feeling during the
night, but I am not sure if I really have any volume in my bladder to speak
of. If you are thinking of overactive bladder, I don't think so. I have
tried detrol LA which is an anti-cholinergic, and it just plugs me up so I
can't pee at all, immediately within 4 hours. I can not take any of the
alpha blockers (including flomax) because they plug my nose up immediately,
and completely.

I have read that as you get older you tend to pee more at night due to the
kidneys not concentrating the urine as much (I believe a normal young
adult's urine production is 2/3 during the day and 1/3 during the night). I
appear to be just the opposite, ie I am not voiding more volume at night as
I get older, and I do not seem to be having one third of my urine production
taking place during the night. I hear others in the group say they void
real good at night after their PVP's etc. Well I can't pee hardly at all
during the late day or at night, but yet I can during the day. So it makes
me wonder if my kidneys just aren't producing a lot of urine at night for
whatever reason(s).

Remember Dr. Sancha, no talk of nephrologists here :-):-) . Another theory
I have is - could it just be my metabolism and it is biological in nature.
But if my kidneys aren't producing as much urine as they should be at night,
then why do I have the urge feeling. I have some free sample catheters from
Lofric and was thinking about self cathing myself in the morning after
urinating to see if, and how much I am retaining, but I really don't want to
do that yet. I have never self cathed and I don't want to stir things up
down there with my prostatitis type problems and my immune deficiency. But
it would give me piece of mind knowing that I am not retaining. I know I
can go to the uro and get a pvr, but like I said, I have been there 20 times
last year, and the self cath would be more accurate anyway.

Dr. Sancha, could you give me a rough order of magnitude on how long it
takes for most liquids to be processed by the kidney after you drink them
(some can be absorbed directly through the stomach versus the small
intestine so that will be relevant I believe). And why does asparagus make
your urine smell really bad. If I eat asparagus I can smell it in my urine
within two hours, so that makes me think the kidney is processing liquids
within two hours. And if you drink a lot of liquids you will start voiding
within two hours, or sooner. Is that approximately correct. And if it is,
what happened to the sixteen ounce glass of water I had with my dinner at
night. I do not pee much of it back out at night. Approximately what
percentage of liquid intake is voided back out when you urinate (ie if you
drink 4 liters of liquid a day, approximately how much passes out as urine
for a normal healthy person).

I apologize for the length of this and for my rambling, and was trying to
figure out how to wrap it up. I hope you get the bulk of what I have been
trying to say. I would like to think my kidneys are working okay (since I
have too many damn other problems), since I can void large amounts, at a
good flow rate during the day. But I don't understand what is going on
later in the day and at night, when it seems that my urethra is closing up,
or my kidneys just aren't producing urine anymore, or both. Please do the
best you can in responding to this. If I can get any piece of mind at all,
it would be greatly appreciated.

Thank you so much once again for all of your support to all of the members
in this newsgroup...Pete


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