Warning about male anatomy and medical TMI and pain.

I got called to the ward to see this old guy who's in urinary retention. No biggie -- happens to a lot of old guys if their prostate is big enough and we know his is massive. Nurse tells me three of them have tried to catheterise him and failed. Uh oh.

So, the more attempts you have, the more the area swells and bleeds. The passageway narrows from the swelling. So the patient gets more difficult to catheterise. And they're sore as hell.

So I spoke to urology, who basically told me (who have succeeded in all four attempts at catheterising straightforward men with normal-sized prostates in my life) I should have a go, even if my super-experienced nurses failed. Now, the poor guy is bleeding (steady trickle) from the trauma to his penis, which is also swollen, and he's pissed off. He refuses my offer to try, if I can't guarantee I'll get it in. Heck, I can probably guarantee I can't. He's at 740mls in his bladder, scanned 3 hours ago, at this point (for reference, the average Joe feels a need to pee at 300-400ml and will get desperate at 600ml-ish). Stretched bladders almost never squeeze of their own accord. If he continues on, he will remain unable to pee then go into renal failure... and die.

So I phoned urology again and they came and shoved the mother of all catheters (20 French) in.

But that's not the end of the story.

Got called to see the guy again two days later. His penis is sore but the bleeding has stopped. Turns out he has a paraphimosis, which happens if either the catheterising person forgets to replace the foreskin after they're done or the foreskin slides back and doesn't get put back. Over time, the skin constricts, squeezing the head of the penis, cutting off blood supply until auto-amputation. Yes, it's what it sounds like.

Of course, the guy isn't at the bad stage yet. So I donned gloves and spent thirty minutes manually reducing that swollen penis. By squeezing it. Hard. The guy's whimpering and I'm apologising 'cos I know this is almost inhumane, but nothing happens. I apply 50% dextrose on a swab (which draws out the swelling via osmosis), wrapped it round, and squeezed again. Nothing.

I called the urology registrar again who fixed him within 5 mins. Sigh.

Moral of the story is: be glad whilst you're young, guys. That prostate comes back and bites you when you hit 80.