[Postprostatectomy dysuria: restored voiding function by perineal hot water spray in an old male with a contractile...

The hot water spray on perineum restored voiding function in a 77-year-old male patient with the poorly contractile bladder. He noticed the gradual decrease of bladder sensation and voiding stream, and needed clean intermittent catheterization to empty bladder even after TUR-P. Neurological examination revealed only weakened anal and bulbocavernosus reflex and impaired skin sensation of foot plate and perineum. Simple cystometry showed impaired perception of bladder filling and underactive bladder. Electromyography of the pelvic floor displayed decreased responses to bladder filling and voluntary sphincter contraction. Spine-X-ray examination and computed tomography of brain and spinal cord did not reveal any neurological lesions except for the silent small infarction of subcortex. Trial of drug therapy with Distigmine bromide, Cernilton and Prazosin did not restore voiding function. By accident, however, patient himself found spontaneous voiding could be induced by hot water spray on perineum and/or scrotum during bidet using. Since then, he has been continuing this stimulation daily for 4 years, with which almost complete voiding is possible without catheterization, though bladder sensation remains impaired. The pathophysiology and affecting factors on micturition reflex in this case were discussed.