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Question : I was not able to pass urine after having a pacemaker put in. I was sent home with catheter attached to a bag. I have a follow-up appointment with the urologist. What if I still can’t pass urine after the catheter is removed? I’d prefer not to have...
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Howard LeWine, M.D.

Howard LeWine, M.D., is chief editor of Internet Publishing, Harvard Health Publications. He is a clinical instructor of medicine at Harvard Medical School and Brigham and Women's Hospital. Dr. LeWine has been a primary care internist and teacher of internal medicine since 1978.

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April 26, 2013
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An inability to urinate is a fairly common side effect of general anesthesia in older men with enlarged prostates. But it’s not clear why it happens.

When you see the urologist, you will likely take a voiding test to see if you can empty your bladder. If you can empty your bladder, the catheter comes out. If you can’t, the catheter will need to stay in for a while longer.

Your doctor will probably start you on one of the alpha blocker drugs. Examples include alfuzosin (Uroxatral) and tamsulosin (Flomax). These drugs help relax the muscles around the urethra where it comes out of the bladder.

The urologist will also do a digital rectal exam to see if your prostate is enlarged. If it is, he or she might also prescribe a second drug to shrink the prostate gland. Doctors most often prescribe finasteride (Proscar) or dutasteride (Avodart). The drugs shrink the prostate by blocking the action of testosterone on prostate cells. The drawback is that it can take several months before you see any effect from Proscar or Avodart.

Prostate surgery is the quickest remedy. There are different ways to do the surgery. But the basic approach is the same. The doctor guides an instrument up the urethra to the prostate and then cuts or lasers away some of the prostate tissue. This rapidly decreases the gland size and urine can start to flow again.

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