Laproscopic without catheter or open with mesh

[QueenR]

Hi,
I am a 60 year old male with a left inguinal hernia diagnosis. I have had previous catheterizations due to complications from treatment for BPH. I was catheterized for an initial TUMT treatment (2005) for the BPH. Four years later I received a green light laser therapy photovaporization of my bladder neck (2009) and also endured catheterization – scarring in my urethra and around the bladder neck due to the microwave treatment for BPH. Then, I was catheterized during an emergency laparoscopic appendectomy (2012), and then immediately re-catheterized a few days later because my urethra and bladder neck had suffered some trauma due to catheterization during surgery for the appendectomy (a teaching hospital in Washington, D.C.). My bladder neck was again resected during that re-catheterization. If you have followed all this you can see that I am not particularly overjoyed at the prospect of being catheterized anymore.

Fast forward to the present moment, and I have found one physician who specializes in laparoscopic hernia treatment and does not use a catheter during the process. I have also consulted with a general surgeon who recommends open repair with mesh, and who expressly said that he does not recommend laparoscopic treatment because he would have to catheterize me if he uses the laparoscopic method. He suggested that it is more risky (to the bladder) to conduct laparoscopic surgery below the navel without using a catheter to shrink the bladder during surgery.

My question is: Is the general surgeon on the right track? The laparoscopic specialist I first mentioned has done a lot of the laparoscopic procedures and seemed to suggest that he rarely if ever catheterizes his patients for the procedure.

[drtowfigh]

Laproscopic without catheter or open with mesh

Some may disagree with my opinion, but I have specifically asked urologists this same question and also seen complications related to the bladder. So here it is:

1. I do not ever recommend any laparoscopic pelvic surgery (appendix, inguinal hernias, lower abdominal incisional hernias) to be performed without decompressing the bladder with a catheter. Why?
– there is a risk of injuring the bladder
– even with urinating prior to surgery, some people may not completely empty their bladder, thus injury to the bladder.
– I have seen multiple complications, such as tacking the mesh to the bladder, or laying the mesh onto the bladder thus resulting in bladder spasms, pain with filling of the bladder, and resultant urinary frequency.

I do combined procedures with prominent urologists in our town. They are very concerned that it is common practice for general surgeons to perform laparoscopic inguinal hernia repair without catheter.

2. Open repair is a valid option, as urinating prior to repair and restricting IV fluids is typically enough to prevent need for catheterization.

[QueenR]

Laproscopic without catheter or open with mesh

Dr. Towfigh,
Thank you for your helpful response. It gives me additional confidence in my choice of providers.

[herniamd]

Laproscopic without catheter or open with mesh

I use catheters selectively with laparoscopic inguinal hernia repairs. I have performed lap repairs since 1993 and have never had a bladder injury. If a patient is at risk for urinary retention, a bladder scan can be performed in the OR after the patient voids and is asleep. If the bladder is empty, they is no need to place a catheter. Many surgeons will use a catheter for every case and this is not incorrect, I just prefer the selective catheterization technique.

[Author]

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