Funnily enough, the day before this started, I had noticed how copious my first flow of the morning had been. However, the next day it was the exact opposite: I couldn't pee. Well, perhaps a little dribble. The next time, a few drops, then for the rest of the day, nothing at all. A fine case, I was later told, of urinary retention.
It was a normal work day and by the afternoon I was getting urges to pee, but nothing came. By evening, these urges were causing me increasing pain, which was centred on my stomach. I tried to go to bed, but the pain was dreadful and at 1.30am on Saturday, I called 111. When I told them I had gone without peeing for 18 hours, they instructed me to get to my local emergency department (ED), at King's College Hospital, London.
The bladder scan was absolute agony. Then a nurse came and explained they were going to catheterise me.
Catheterisation
The catheterisation was beautifully done. A nursing staff member who introduced himself as Ramuel, came to insert the catheter. He told me he was putting anaesthetic on the head of my penis and that inserting the catheter might hurt. In fact, he did it so smoothly and swiftly, it hardly hurt at all. Almost immediately, I felt huge relief. He kept updating me on progress of my urine into the bag: ‘Oh, that's 300 ml, 700 ml now.’ Eventually, I filled the bag to 1.5 litres.
A doctor came and asked permission to make a rectal examination in case an enlarged prostate had caused my urinary retention. She waited to do it until a nurse was present as chaperone, but found no enlargement of the prostate. The same nurse came by with a catheter kit of: leg bag, night bag and catheter ‘passport’ (an explanatory leaflet). The doctor said the catheter would be in for ‘1 or 2 weeks’.
A week later, I fainted in the street and was taken by ambulance to ED at King's College Hospital. I was told I had a severe bladder infection, due to the catheter, doubtless, which, combined with the heat, had caused me to faint. I was given a course of antibiotics.
In total, I had the catheter for 5 weeks. It was a time of a lot of inconvenience and humiliation. The worst was when urine leaked from my penis (ie, I wet myself). I was told this was not supposed to happen with the catheter, but it did, several times. The bags failed, valves popped out of supposedly secure connections, again wetting me. When I went out, I was afraid people would see the bag or its protruding tap valve, or that the straps would not hold. At night, I had to attach a night bag with its huge tube snaking out of bed, again worrying that I would pull it out in my sleep.
It was a terribly lonely experience. Not once in all those 5 weeks did any health professional phone me to see how I was getting on with the catheter. Just one call would have made a huge difference.
Meanwhile, my GP contacted the urology department to ask when I was due to have the catheter removed, as I'd had no appointment letter. Within an hour of her talking to the urologist, he phoned me late on Tuesday afternoon and said the magic words: ‘Would you be able to come into King's at 9am this Thursday?’
Trial without catheter clinic
I was early for my appointment at the trial without catheter (TWOC) clinic. The point of the TWOC is not merely to remove the catheter, but to check that you are able to pee as normal—if not, it's back to the catheter, a prospect that dismayed me. In my case, it took about 4 hours to verify.
The consultant handed me over to Staff Nurse Grace, who was to help me through it all. She began by introducing herself and throughout the morning was good-humoured, respectful and deeply caring. The first thing Grace did was to attach a fresh leg bag, so she could test my urine for infection. Having got the go-ahead from the consultant, she removed the catheter. ‘This may feel strange,’ the appointment letter said, ‘but it should not hurt.’ All I can say is that it absolutely did: savage, though brief, pain. Why anyone thinks the removal of a great tube of plastic from your penis won't hurt is a mystery.
Over the next few hours, I was told to drink 6 cups of water and every time I felt the urge, to take a cardboard urine bottle with my name on it from the sluice and go into the toilet next door to fill it. With all six glasses drunk and four trips to the sluice, I had produced enough to satisfy Grace that I had passed the TWOC. She scanned my bladder and all was satisfactory. ‘Now,’ she said, ‘without drinking any more water, you're to go to the toilet when next you feel like it, not using the bottle, but just the ordinary toilet. When you're done, come to the nurses' station and tell us, and you're free to go.’ Ten minutes later, having thanked Grace for all her care, I was homeward bound, free of a catheter for the first time in 5 weeks. I walked tall, on air.
Conclusion
As a patient, I have the highest praise for Ramuel, who inserted my catheter, and for Grace, who removed it. But the lack of any care between those two points for the 5-week-long stressful and humiliating business of wearing a catheter, and the fact that the system seemed to have lost sight of me, so it took my GP's persistence to get to the TWOC clinic, were definite downsides.
After a few days of discomfort from the removal, I am back to normal, but with a recognition that, for me, normal urination is not to be taken for granted but is in fact a great gift.