To pee, or not to pee

May 21 2011 Published by under Medicine

Folks, I am so tired of not writing every day.  I knew with the new job I'd be cutting back quite a bit, but then with MrsPal's illness, all my writing time has gone right into the Foley bag.

By the way, a Foley catheter is not something one should try to remove on their own.  Many men and some women have had the pleasure of hosting a Foley catheter because there are times in a person's life when they may not be able to pee for themselves. This is particularly true of males.

Men are more frequently invaded by urinary catheters because of an anatomic accident, but women have their own anatomic annoyance, the urinary tract infection (UTI).  To understand how people's sexy bits can become so un-sexy, we need to learn a little anatomy (and this is about to get clinically graphic so I'm putting in a page break.  You've been warned).I'm drinking a very nice gunpowder green tea.  Eventually my kidneys will figure out that I've ingested extra water and they will send some of that water down my ureters into my bladder.  From there, the tea (now urine) can pass easily through my urethra into the toilet (or perhaps the side of a pine tree were I camping, or the side of a building were I a sociopathic fratboy).
A significant portion of my urethra passes through the prostate gland, a potential bottleneck unique to males. (The bottleneck is unique to males, but females do have a homologous organ, Skene's gland, now officially known as the "female prostate gland".)  There are many reasons urine might not be able to pass from the bladder to the environment but the prostate is at the top of the list.  Infection, cancer, or simply increasing size with age can cut off the supply of urine, causing a slow, inconsistent stream, a feeling of incomplete emptying, and other symptoms known collectively as "lower urinary tract symptoms" (LUTS).

There are plenty of drugs and operative procedures that can help relieve this, but from time to time the flow of urine is cut off leading to a crisis.  If urine can't flow out of the bladder, it backs up into the kidneys.  This can lead to severe infection and kidney failure.  But we have a plan.

A long rubber tube can be passed (carefully) through the tip of the urethra, past the prostate, and into the bladder, relieving the obstruction.  To keep the tube from slipping out, a balloon is inflated at the end.  Of course, not all men will be happy with a rubber tube in their penis, and if you take an older man, put a tube up there, put him in a hospital delirious with fever, there's a greater than zero chance he'll pull on that tube until it is on the floor, balloon and all.  This may cause a bit of trauma, and about this I will say no more.
Let's move on to the latter part of the female urinary tract.  You may have noticed one way or another that the male urethra is a bit longer than the female version---it comes with a built in "extender".  In women, everything is much closer together.  Labelled "6" in the picture to the right is the urethra.  Labelled "14" is the anus. ("7" is the entrance to the vagina.) Urine is normally sterile.  The anus, not so much.
Bacteria can make there way from the rectum to the urethra, and if they are fortunate, take up residence and cause an infection of the urethra, bladder, or kidneys.  Most women will  first notice this as discomfort on urinating, perhaps a burning, and while this is often all there is to it, this may progress to high fevers, horrible flank pain, and a stay in the hospital.

Most of the organisms isolated from urine cultures are the same ones often found in stool, which is why we advise women to wipe from front to back after voiding.  Women who get frequent infections are often advised to pee immediately after sex, but there is little evidence to support this.

I'm quite done with my tea, and now I'm going to move on to another East Asian beverage, this one recommended by a colleague.  It turns out that for those of us who aren't alcoholics, a little sip of shochu before turning in can be a lovely distraction.

But I know it's going to make me have to get up to pee later.


(all images in the from wikimedia commons)

8 responses so far

  • WhizBANG! says:

    Urine is golden.

  • Glfadkt says:

    As I always tell the 1st year med students at the beginning of the renal physiology lecture block: You drink --> you pee. (If you don't, you die...)

  • WMDKitty says:

    *quietly crosses legs*

  • Ryan E. says:

    Still beats the time I spent the night with my friend in the hospital, and she pulled out her Zazi tube (no idea of the correct spelling of that). Seems like Fentanyl messes with your head.

  • george.w says:

    Have had way more experience with Foley catheters than I wish were the case, but the cystoscope is much worse. After a recent intrusion by that visitor, I was in awful pain and bled for two days. My co-worker, a young fellow, asked me why I missed work; I told him to go on Wikipedia and look up "cystoscopy". He did and studied the page intently. After a moment he said "Oh my god!" and covered his mouth with his hand. I thought he was going to crawl under the desk.

    File the human urinary tract under "(un-) Intelligent Design?"

  • DLC says:

    Well, I always thought of the Urethra as an exit. . .

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