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Thread: New SCI- bladder questions

  1. #1

    New SCI- bladder questions

    Hi all, I suffered a burst fracture of my T12 this past April in which my spinal cord was compressed about 50%. I had surgery to repair the fracture and relieve pressure on the spinal cord within 72 hours. The surgery went well, and in the 7 months since the injury, I have regained most of my function (including walking, which was almost immediately after surgery) with the exception of bladder, bowel, and some sexual dysfunction.
    I intermittently catheterize myself 5-6 times per day and have not had a UTI. However, starting about 6 weeks ago, I have been experiencing a variety of symptoms/sensations in my penis, ranging from what I would describe as a burning or tinging sensation to what feels like an increased urgency to void. I have had urinalysis completed, which come back clean and most recently saw a urologist who ordered a urodynamics test and cystoscopy. I had the urodynamics done last week, though they were unable to complete the test as I became lightheaded during the procedure and ended up losing consciousness for a few moments, forcing them to abort the test. Before they ended the test, however, they did note pressure increasing at a relatively low volume in my bladder (about 200 ml) and some reflux, the urine working its way back up one of the ureters.
    The testing nurse noted what happened, and I am scheduled to see the urologist for the cystoscopy and discuss the (incomplete) results of the urodynamics. Unfortunately, that isn't for a month yet.
    I am reaching out to other SCI victims, wondering if the burning/tingling/increased sensation is "normal" in that it is the nerves changing or settling or "waking up" or whatever it is they do during healing. I am hoping to get more definitive answers from the urologist when I see him, but oftentimes the answers I receive when I pose this question is that they "don't know" and that it "could be". Has anyone else experienced tingling/burning in their genitals that wasn't related to a UTI?
    Thank you in advance for your answers. It has been wonderful finding this forum and "listening" to what others before me have experienced.

  2. #2
    Quote Originally Posted by Chris L View Post
    Hi all, I suffered a burst fracture of my T12 this past April in which my spinal cord was compressed about 50%. I had surgery to repair the fracture and relieve pressure on the spinal cord within 72 hours. The surgery went well, and in the 7 months since the injury, I have regained most of my function (including walking, which was almost immediately after surgery) with the exception of bladder, bowel, and some sexual dysfunction.
    I intermittently catheterize myself 5-6 times per day and have not had a UTI. However, starting about 6 weeks ago, I have been experiencing a variety of symptoms/sensations in my penis, ranging from what I would describe as a burning or tinging sensation to what feels like an increased urgency to void. I have had urinalysis completed, which come back clean and most recently saw a urologist who ordered a urodynamics test and cystoscopy. I had the urodynamics done last week, though they were unable to complete the test as I became lightheaded during the procedure and ended up losing consciousness for a few moments, forcing them to abort the test. Before they ended the test, however, they did note pressure increasing at a relatively low volume in my bladder (about 200 ml) and some reflux, the urine working its way back up one of the ureters.
    The testing nurse noted what happened, and I am scheduled to see the urologist for the cystoscopy and discuss the (incomplete) results of the urodynamics. Unfortunately, that isn't for a month yet.
    I am reaching out to other SCI victims, wondering if the burning/tingling/increased sensation is "normal" in that it is the nerves changing or settling or "waking up" or whatever it is they do during healing. I am hoping to get more definitive answers from the urologist when I see him, but oftentimes the answers I receive when I pose this question is that they "don't know" and that it "could be". Has anyone else experienced tingling/burning in their genitals that wasn't related to a UTI?
    Thank you in advance for your answers. It has been wonderful finding this forum and "listening" to what others before me have experienced.
    Do you take any anticholinergic agents like Oxybutinin to diminish bladder spasms? These antispasmodic medications can help your bladder hold more urine before the bladder spasms start. Ideally, on an intermittent cath program you want to cath at a bladder capacity of about 350cc to 400cc which translates to 4 to 6 caths per day.

    You may want to discuss bladder Botox with your urologist. The Botox injections also reduce bladder spasms. You need to have this procedure done about every 6-8 months. Try searching this site for more information.

    You have done and are doing the right things to check your bladder health by getting the urodynamics and cystoscopy.

    All the best,
    GJ

  3. #3
    The oxybutynin (dose 10 mg three times a day)- relaxes the bladder. was your increase in pressure a resting pressure? loss of compliance. what was your blood pressure during this time? Sound like a loss of compliance- and did you void or not? and was that pressure high? Either way- oxybutynin will help. And they will retest you on that. If that doesn't work they can do botox.WERE YOU SEMI-LYING DOWN AND YOU PASSED OUT OR SITTING UP?
    And yes you could be having a type of neuropathic pain or sensation and it may not be a UtI.
    CWO

  4. #4
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  5. #5
    Quote Originally Posted by SCI-Nurse View Post
    The oxybutynin (dose 10 mg three times a day)- relaxes the bladder. was your increase in pressure a resting pressure? loss of compliance. what was your blood pressure during this time? Sound like a loss of compliance- and did you void or not? and was that pressure high? Either way- oxybutynin will help. And they will retest you on that. If that doesn't work they can do botox.WERE YOU SEMI-LYING DOWN AND YOU PASSED OUT OR SITTING UP?
    And yes you could be having a type of neuropathic pain or sensation and it may not be a UtI.
    CWO
    The nurse doing the urodynamic test did mention that my bladder was considered "non-compliant"- the increase in pressure was a resting pressure( if by that you mean I wasn't trying to push or void at the time). I did not void at the time- once I passed out (I was standing at the time I began to get lightheaded and asked to be seated. I passed out while I was in the sitting position), they immediately removed the catheters from me. I did not void. Later, after I regained consciousness, they cathed me again to empty my bladder.
    I have heard of the oxybutynin but know little about it. Does this help in allowing the bladder to expand and prevent reflux? During the testing, the nurse did NOT note any spasms of the bladder... just the increase in pressure and the reflux.
    If the oxybutynin relaxes the bladder, does it do anything to relax the bladder sphincter muscle? Unfortunately, because I did not complete the test, they were not able to determine if my bladder acts normal and starts to contract when it is filled to a certain volume. So at this point, the assumption is that I may have a flaccid bladder and a sphincter that will not release and allow the urine to pass through it.
    Since my injury is relatively new, I am still curious as to the percentage of SCI victims who actually recover bladder function enough that they no longer need to cath. The doctors around here seem very reluctant to cite any statistics. I'm not trying to be overly hopeful, but am more interested in finding out what chances remain that I will recover bladder function, now seven months out from injury.
    Thanks again for your very helpful responses.

  6. #6
    We don't UDS standing. No reason to do so, if the bladder is going to contract it will contract sitting or standing and doesn't affect that. We have the person void and check a post void residual when the catheter is put in and compare with the test void.
    Urodynamics is all about the pressures and the kidney.
    It is like chekcing your blood pressure- no one really cares what th epressure in your arm is but the correlation with heart problems, stroke, kidney failure etc..... is the issue and the bladder pressure can be too high and the kidney can't produces and empty urien effectively and kidney damage can occur. The rise in pressures is the first sign and can only be picked up in Urodynamics- the complete urodynamics with the catheter in with special sensor devices for pressure.
    Oxybutynin relaxes the bladder and helps itr hold more. The regular acting Oxybutynin lasts for about four to six hours. By relaxing the bladder it does two things- lowers the resting pressure and allows the bladder to hold more. You need to see what your voidng pressure is- or the pressure if you had a contraction which may or may not make you urinate.Not when you push but when your bladder has a contraction on its own unless you have an areflexic bladder which does not have a contraction at all or has low aamplitude contraction- or low pressure cotnraction.
    With the high voiding pressure and or high resting pressure9 Loss of compliance, noncompliance) both issues you need to decrease and relax the bladder. Andthe anticholinergic like Oxyubutynin is most likely what will be ordered and you need to make sure the lbadder is emptied and catheterization maybe necesary. And even if you do void, if that voiding pressure is really high, we have to lower that pressure and use Oxybutynin and catheterization- to prevent high rpessure and problems that can arise with the kidneys- so it is not jdut about voiding it is about voiding safe in regards to the kidneys.
    High voiding pressures occur because the bladder is contracting and trying to push past an obstruction. Usually a sphincter. or can also be a stricture or enlarged prostate. If it is very high and you have DSD-detrusor sphincter dysnergy-causing a high voiding pressure and the bladder just voids a little and the high voiding pressure may cause back up (or reflux) up the ureters that go to the kidney- can be one or both and the valve that is there can't keep the high pressure from the bladder and can cause hydronephrosis or fludi on the kidneys that can oead to kidney damage and if not treated could lead ot kidney failure. This doesn't happen like it used to 30 years ago because of urodynamcis and what we have learned. High voiding and or voidng pressure and full bladders and back up the ureters and to the kidney and resultantdamage is what must be avoided. That is why we seldom let let people strain void, crede' or push on their bladder to get voiding started and we use little reflex voiding for management- or will do urodyamics to test if the regimen they are doing is SAFE. i.e. normal resting and voidng pressures and not sky high when strain voiding or triggering or pushing. Kidney damagel failure and Deathfrom kidney issues used to be the number one cause of death and or alot of renal dialysis.
    Our most common recommendation tx Oxubutyinin 10 mg three times a day and have them cath every four to six hours and will actually tell them we don't want them to void if the voiding pressure is high- it can be double or over 100. Anything over 55-60 is considered high and any resting pressure over 13 is high but especially over 35- at 35 the kidney ureters cannot mild down the urine and then you get the backup. Urodynamcis picks this up before any renal ultrasound or test so it needs tob e treated and taken care of and tested to prevent any kidney damage.
    Or the indwellling cathter is an option but we prefer intermittent catheterization and oxybutynin if person or caregiver can cath.
    The other bladder type is the NDU-neurogenic underactivity. there is no bladder cotnraction so the bladder doesn't empty. The sphincter isn't the real problem here. This bladder usually has flat lines but can have a loss of compliance at resting and if the sphincter is denervated can also have leaking. And Oxybutynin will be ordered with the intermittent cathing. Strain voiding can be done by men but we have to test the pressure and see what the pressures are when they strain void and may be harmful withhigh pressures and intermitten cathterization to keep the kidney SAFE is the whole issues for both these bladders.
    Another medication we are using more of is Tamsulosing 0.4 mg once a day. It is an alpha blocker and research shows that it can lower bladder pressures and it works on decreasing the size of the prostate and possibly helps relax the muscles and the sphincter and may help with emptyingt and voiding. Both Oxybutynin and Tamsulosin can be taken-bladder is different type fo muscle than sphincter. But we usually start one at a time. And with loss of compliance you need the anticholinergic like Oxybutynin.
    I am sure the urologist will explain all this to you. You should start your treatment and have urodynamcis after being on med(s) for two to three months. Also a 24 hour urine and renal ultrasound should be done- we do these once a year atleast.
    CWO

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