frequent uti - NURSE advice needed please

[ouch]

I'm a c 6-7 10 yr post injury. I wear a condom cath during the day and night. I take cardura to loosen the sphincter b/c I get fragmented autonomic dysreflexia every time I void with symptoms of sweating, goosebumps, stronger heartbeat, etc. I straight cath in the morning and night to empty my bladder totally. I've always had a problem with uti's.. what a surprise. However, I can not go a week off antibiotics without getting one the past 6 months. It is always the same bug... klebsiella. I'm beyond frustrated. My volumes I cath out I notice have increased. They used to be 300 max. Last night I cathed out 700, andthis morning 650. They average 400. Too much. So...

Might it help me to switch to an indwelling cath for a period of time to tighten my bladder back up? How long if I do this?

Whats uroquid? Is it safe?

Is there a reference on the web or past post.. I couldn't find on all the tests an sci person should have regarding urodynamics? Names and procedures? For instance, I've had dye tests and one where they watched the ureters empty into the bladder. I remember reading about video dynamics or something here in the past. Was that the test? Going into urologist next tuesday so want to be prepared and get feedback here first.

I've tried cranberry pills, manno max, and drink a ton of water daily. I know when I get a uti b/c it will show sediment at the end of my cathing. thanks

[SCI-Nurse]

You need to have annual urodynamics to determine if you have a high pressure bladder, which would appear to be the case from your description. This can cause AD and damage to your kidneys as well as frequent UTIs. Ideally videourodynamics are the best test, but you should at least have a CMG combined with a sphincter EMG with fluoroscopy to look for reflux and bladder neck behavior.

Cardura only helps relax the internal urinary sphincter (bladder neck) and does nothing for the external urinary sphincter which is usually the cause of DSD and high pressures in men with SCI.

You should also be checked for presence of stones, which can cause recurrent infections with the same bug (ultrasound or CT scan) and for prostatitis (infection of the prostate) which can also cause this.

Using anticholonergics to keep you dry and lower your pressures and doing intermittent cath 6X daily would probably be the safest method of bladder management for you, and would allow you to be "bag free" as well. We rarely recommend externals for those who are able to self-cath anymore. Most who use an external need to have their external sphincter cut (sphincterotomy) or a urethral stent to control their spastic sphincter. An indwelling catheter will only shrink your bladder and make you more prone to UTIs, stones and other complications such as bladder cancer.

You should only be treating symptomatic UTIs. This is NOT a positive culture or sedament in your urine...you must have chills, fever, AD and other serious symptoms. If you treat for sediment or positive culture, you will end up with resistant organisms, which may be the case with your klebsiella. Has your treatment with antibiotics been consistently based on culture and sensitivities and not just a positive culture or Gram stain?

http://www.ahrq.gov/clinic/epcsums/utisumm.htm

Be sure your new urologist is expert in neurologic urology. Don't hesitate to find another one if this is not the case.

(KLD)

[ouch]

Has your treatment with antibiotics been consistently based on culture and sensitivities and not just a positive culture or Gram stain?
>>>

treatment has been based off sensitivities. Usually cipro.

What anticholonergics are most frequently used now? I used ditropan right after my injury trying the intermittent cath thing and had frequent accidents.

Thanks for the advice. I've had this urologist since my injury. Might be time for a change.

[SCI-Nurse]

Anticholergics include Ditropan and Ditropan XL, Detrol and Detrol LA as well as minor anticholergics such as Levsin. Tricyclic antidepressants (in low doses) such as imipramine are also used frequently for their anticholergic effects. Dosage must be appropriately adjusted, combinations may be needed. Ditropan can be given as a bladder instillation if side effects are a problem.

(KLD)