I saw a urologist for burning and frequent urination. He diagnosed BPH and incomplete bladder emptying. I had a Foley catheter for about three weeks and developed a urinary tract infection before it was removed. Antibiotics cleared the infection and my urine stream became stronger.
My doctor has now suggested intermittent self-catheterization, which I prefer to having a Foley catheter. He has not performed an annual digital rectal examination or PSA test. I expected those tests when I first saw him. What are your thoughts?
Quick Answer
Your situation is more accurately described as BPH with significant incomplete bladder emptying or urinary retention, rather than simply uncomplicated enlarged-prostate symptoms.
If ongoing bladder drainage is required and you are physically able to do it, clean intermittent self-catheterization is generally preferable to a long-term indwelling Foley catheter. It avoids leaving a catheter continuously in the urethra and can reduce some of the morbidity associated with chronic indwelling drainage.
However, catheterization manages the retained urine; it does not remove the cause. Your urologist should determine whether the retention is mainly caused by prostate obstruction, weak bladder muscle, urethral narrowing, or another problem. If BPH is producing refractory retention, a procedure to relieve the obstruction may eventually be more appropriate than indefinite catheterization.
PSA and digital rectal examination (DRE) are not automatically required at every BPH visit or every year. PSA is the main prostate-cancer screening blood test when screening is appropriate, but urinary infection and acute urinary retention can temporarily raise PSA, so timing matters.
Hello Joe,
You have already experienced one of the important complications of poor bladder emptying: the need for catheter drainage, followed by a catheter-associated urinary infection. Because of that, I would focus less on trying to “cure” the prostate with diet or herbal products and more on understanding why your bladder is retaining urine and whether the obstruction can be corrected.
Why Did You Need a Foley Catheter?
When a man cannot empty his bladder adequately, the bladder may remain chronically overfilled. This can cause:
- frequent small urinations;
- urgency;
- weak flow;
- a feeling of incomplete emptying;
- overflow leakage;
- recurrent urinary infection;
- bladder stones; and, in more severe cases,
- pressure effects on the kidneys.
A catheter drains the retained urine and protects the bladder and kidneys while the cause is investigated or treated.
See our guide to incomplete bladder emptying and urinary retention.
Is Intermittent Self-Catheterization Better Than a Foley?
For many patients who need ongoing bladder drainage and can perform the technique themselves, yes.
An indwelling Foley remains continuously inside the urethra and bladder. Intermittent catheterization involves inserting the catheter only long enough to empty the bladder and then removing it.
American Urological Association guidance on chronic urinary retention considers intermittent catheterization a reasonable treatment for symptomatic retention and generally preferable for long-term bladder drainage in patients who can perform it or have help available.
The CDC similarly states that intermittent catheterization is preferable to indwelling urethral or suprapubic catheterization in patients with bladder-emptying dysfunction.
How Often Should You Self-Catheterize?
There is no universal schedule that is correct for every patient.
The frequency depends on:
- how much urine remains after you void;
- how much urine your bladder can safely hold;
- your fluid intake;
- whether you can urinate between catheterizations;
- kidney function;
- infection history; and
- your urologist’s treatment goal.
CDC guidance recommends performing intermittent catheterization at regular intervals to prevent bladder overdistension.
Your doctor may use a bladder scanner and your catheterized urine volumes to adjust the schedule.
Does Intermittent Catheterization Eliminate UTI Risk?
No. Any catheter that enters the bladder can introduce bacteria.
However, leaving a Foley catheter continuously in place creates a persistent pathway for bacterial colonization and catheter-associated infection.
For chronic intermittent catheterization outside an acute-care setting, CDC guidance states that a clean technique is an acceptable practical alternative to a sterile technique.
Should You Take Antibiotics to Prevent Another UTI?
Not routinely.
CDC guidance advises against routinely giving systemic antibiotics simply to prevent catheter-associated infection in patients who require short- or long-term catheterization.
If you develop symptoms suggesting infection—such as burning, new urgency, fever, chills, pelvic pain, flank pain or feeling acutely unwell—your clinician can obtain urine testing and decide whether treatment is needed.
Catheter users may have bacteria in the urine without true infection, so symptoms and culture findings should be interpreted together.
Should You Keep Repeating Urinalysis After the Infection Clears?
Not indefinitely if you feel well.
The old page recommended repeatedly checking urine after treatment, even suggesting multiple routine repeat tests. That is not standard for every patient.
Modern infection guidance does not recommend routine post-treatment urine testing in patients whose symptoms have resolved, unless there is a specific clinical reason.
Your history of retention and catheter use means recurrent symptoms deserve attention, but testing should be driven by symptoms, risk factors and your urologist’s follow-up plan rather than performed continuously.
Why Might Your Stream Have Improved After the Foley Was Removed?
Several explanations are possible.
Draining an overdistended bladder and treating the UTI may have reduced inflammation and allowed more effective voiding. If you were also started on a BPH medication such as an alpha blocker, that could also improve urine flow.
But a temporarily stronger stream does not prove that the underlying obstruction has resolved.
The important follow-up measurement is the post-void residual (PVR): how much urine remains after you urinate.
What Should Be Evaluated Now?
Because you have already required prolonged catheterization and are now self-catheterizing, I would expect a more detailed assessment than is needed for mild uncomplicated BPH.
Post-Void Residual
A bladder scan or ultrasound measures how much urine remains after voiding.
Uroflowmetry
This measures the rate and pattern of your urine flow.
Prostate Size and Anatomy
Ultrasound, cystoscopy or other imaging can help determine prostate size and whether there is a median lobe or another anatomical source of obstruction.
Kidney Function
Kidney blood tests and, in selected patients, upper urinary tract imaging may be appropriate when chronic retention is significant.
Cystoscopy
A urologist may look directly inside the urethra and bladder when urethral stricture, bladder stone, tumour or anatomic obstruction needs to be excluded.
Urodynamic Testing
This can be particularly helpful when the urologist needs to distinguish bladder outlet obstruction from a weak bladder muscle.
That distinction matters because prostate surgery works best when obstruction is the major reason urine is not emptying.
Does an Elevated Residual Automatically Mean You Need Surgery?
No.
AUA guidance specifically warns against using an elevated PVR as the sole reason for bladder-outlet surgery.
The decision should consider:
- whether the retention is due to BPH obstruction;
- how high and persistent the residual is;
- kidney function;
- hydronephrosis;
- recurrent symptomatic urinary infection;
- bladder stones;
- how much the condition affects quality of life; and
- whether the bladder muscle can still contract effectively.
When Does BPH-Related Retention Make Surgery More Appropriate?
The AUA recommends surgery when BPH causes:
- refractory urinary retention;
- kidney insufficiency caused by BPH;
- recurrent urinary infections related to obstruction;
- recurrent bladder stones;
- recurrent gross hematuria attributed to BPH; or
- lower urinary tract symptoms that remain unacceptable despite, or instead of, other therapies.
If you continue to require catheterization because your prostate is blocking urine flow, I would ask the urologist whether a BPH procedure to relieve the obstruction offers a reasonable chance of allowing you to stop catheterizing.
Could Medication Help You Stop Catheterizing?
Possibly, depending on the cause and severity of the retention.
Alpha Blockers
Medicines such as tamsulosin can relax smooth muscle at the prostate and bladder neck and may improve the chance of successful urination after catheter drainage in selected men with BPH-related retention.
5-Alpha-Reductase Inhibitors
Finasteride or dutasteride can gradually reduce prostate volume and lower the long-term risk of acute urinary retention and BPH-related surgery in men with enlarged prostates.
They work over months rather than immediately.
See our BPH medication guide.
Should Your Urologist Have Done a PSA Test?
It depends on your age, previous PSA history, prostate-cancer risk and whether screening would benefit you.
For prostate-cancer screening, current AUA guidance identifies the PSA blood test as the first screening test. A DRE can sometimes provide additional clinical information but is not the primary screening test.
There is also a practical reason your urologist may have delayed PSA testing while you had a urinary infection and urinary retention.
This does not mean PSA must be delayed indefinitely. It means the test should be ordered at a clinically meaningful time.
Do You Need a Digital Rectal Examination Every Year?
Not automatically.
A DRE allows the clinician to assess the prostate’s approximate size, firmness, symmetry and any obvious abnormal area. It may be useful during evaluation of BPH or when prostate cancer is suspected.
But modern prostate-cancer screening does not require that every man undergo a DRE every year.
If you have never had a prostate examination during the current evaluation, it is reasonable to ask your urologist whether a DRE would add useful information in your case.
Does PSA “Exclude” Prostate Cancer?
No.
The original answer described PSA as a test used to exclude prostate cancer. That is too definite.
PSA is a risk-assessment and screening tool. BPH, infection, inflammation, urinary retention and prostate cancer can all affect PSA. A normal PSA does not absolutely rule out cancer, and an elevated PSA does not automatically mean cancer.
See our guide to interpreting PSA.
Should You Drink Uva Ursi or Rose-Hip Tea?
I would not recommend either as treatment for BPH-related retention or as prevention for catheter-associated UTI.
There is no good evidence that these teas restore bladder emptying, remove prostate obstruction or prevent catheter infection.
If urinary retention is significant enough that you need intermittent catheterization, herbal treatment should not delay proper urological management.
Do You Need to Avoid Coffee, Spicy Foods and Acidic Foods?
Not every man needs a restrictive “prostate diet.”
Caffeine and alcohol can aggravate urgency or frequency in some people, so reducing them is reasonable if you notice a clear relationship.
Spicy or acidic foods may irritate the bladder in some individuals, but they do not cause BPH and eliminating them will not correct urinary retention.
Should You Avoid Water at Dinner or Bedtime?
Reducing large amounts of fluid for a few hours before bed can help nocturia, but do not deliberately dehydrate yourself.
Someone performing intermittent catheterization still needs reasonable hydration unless a clinician has prescribed fluid restriction because of heart, kidney or another medical condition.
Should You Stop Jogging or Cycling?
No blanket prohibition is necessary.
Physical activity is generally beneficial to overall health. Cycling can cause temporary perineal pressure or discomfort in some men, but there is no evidence that men with uncomplicated BPH must stop cycling or jogging to protect the prostate.
If a particular activity clearly causes pain, bleeding, urinary irritation or catheter-related problems, modify it and discuss the symptoms with your clinician.
Questions I Would Ask Your Urologist
- What is my post-void residual when I try to urinate without catheterizing?
- Is my retention primarily from prostate obstruction or weak bladder muscle?
- What is my prostate size and anatomy?
- Would uroflowmetry, cystoscopy or urodynamics help clarify the cause?
- How often should I self-catheterize based on my bladder volumes?
- Am I taking the appropriate BPH medication?
- Is there a realistic chance that a prostate procedure would allow me to stop catheterizing?
- Do my kidneys need imaging or laboratory monitoring because of the retention?
- Once the infection and acute retention have settled, is PSA screening appropriate for me?
When Should You Get Urgent Medical Help?
- you cannot pass the catheter and your bladder is becoming painful or very full;
- you cannot urinate and cannot catheterize;
- you develop fever, chills or shaking;
- you develop flank or kidney-area pain;
- you have significant blood or clots in the urine;
- you develop severe lower abdominal pain; or
- you become confused, weak or acutely unwell.
Your preference for intermittent self-catheterization over a long-term Foley is reasonable and is consistent with current guidance for many patients with chronic bladder-emptying dysfunction.
However, because you still require catheterization, I would not consider the underlying BPH problem solved. I would ask your urologist specifically whether the retention is caused by prostate obstruction, whether your bladder muscle is functioning adequately, and whether a BPH procedure could realistically allow you to empty without a catheter.
I would also ask about PSA once the urinary infection and acute retention episode have settled, if prostate-cancer screening is appropriate for your age and health. I would not be concerned simply because a DRE has not been performed “yearly”; annual DRE is not a universal modern screening requirement.
Finally, I would not substitute repeated urine tests, uva ursi, rose-hip tea or restrictive diets for proper evaluation of chronic urinary retention.
Dr. Albana Greca, MD, MMedSc
Family Physician / General Practitioner
Founder & Lead Medical Author, Prostate Treatment Options
Medical References
American Urological Association. Management of Lower Urinary Tract Symptoms Attributed to Benign Prostatic Hyperplasia: Guideline Amendment 2023.
American Urological Association. Non-Neurogenic Chronic Urinary Retention: Consensus Definition, Management Strategies, and Future Opportunities.
American Urological Association / Society of Urologic Oncology. Early Detection of Prostate Cancer Guideline, 2023.
Centers for Disease Control and Prevention. Guideline for Prevention of Catheter-Associated Urinary Tract Infections: Summary of Recommendations.
National Institute of Diabetes and Digestive and Kidney Diseases. Treatment of Urinary Retention and Enlarged Prostate (BPH).
European Association of Urology. 2026 Guidelines on Male Lower Urinary Tract Symptoms and Prostate Cancer Diagnostic Evaluation.
Last evidence update: September 2026.