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Thread: Bladder Surgery Q's

  1. #11
    Quote Originally Posted by bartoj View Post
    Yes, GJ,
    I actually did my rehab at Northeast. They did not have that much experience with SCI in my opinion. Also they were not CARF accredited at the time. In hindsight they could have spent more time with teaching IC and I never would have been on this fork in road I'm at today.

    However I will call them just to see if they have new recommendations besides the DR who screwed up the incision to begin with.

    Millard, based on last months urodynamics, I barely held 100 cc's before it started backing up. I'm glad you were able to resolve to the SP. I've talked with many Dr's who are adamant that they shouldn't be used. So I have that in the back of my mind as I look for alternatives.
    I hope you have better luck with Northeast.

    I know what you are saying about some urologists being adamant about suprapublic catheters. I once had a urologist tell me the procedure was "barbaric." But for me, at age 64 when I had my suprapubic done, I was at the end of the line. Thirty years ago, when I was injured I started this journey on a male external catheter for about 18 years. Once urodynamaic studies showed pressures that were too high, I went to intermittent catheterization, until a series of recurrent urinary tract infections (my immune system became compromised with the onset of non Hodgkins lymphoma and chemotherapy) forced me to an indwelling urethral catheter which wasn't much better than intermittent catheterization in regard to infections. I met with some highly regarded neuro-urologists at University of San Francisco and Stanford University and after weighing all the options, settled on the suprapubic as a baby step before more complex and invasive forms of bladder management.

    Fortunately, my suprapubic was executed well and with daily instillations of Vetericyn, I have remained infection free for 2 years. I started out with a leg bag while using the external catheters (I know not an option for a female) and have one again with the suprapubic. The leg bag isn't an issure for me.

    All the best,
    GJ

  2. #12
    I am 4 1/2 years post injury and have had an indwelling catheter the entire time, urethral initially and suprapubic since last fall. While I was still in the hospital following my injury, the nurses attempted to teach me to self cath, but my bladder spasms were so strong I was constantly urinating, earning the nickname "Little Niagara". No one suggested medication, and of course I didn't know what sort of suggestions to make at that time. After being discharged, I was having one UTI after another, causing me to leak profusely, and prompted me to seek a urologist who had experience with neurogenic bladders. I didn't have a clue where to look, so I asked my physiatrist for a recommendation. With the prolonged use of the foley catheter, I had quickly worked my way up to a 30cc balloon, as anything less than that would come out, sometimes fully inflated. My new urologist claimed that my urethra was still healthy, but immediately recommended switching to suprapubic catheterization because of the incessant infections. Since making the switch, I have not had a single UTI, but am seriously considering discussing intermittent catheterization with her. Sometimes (like the present moment), after I have my catheter changed (once per month), I leak around my urethra for a few days following. It doesn't always happen, but enough to be bothersome. Also, one year post injury my bladder was already holding only 250cc, so I can only imagine what it's down to now (and should probably get that checked out, come to think of it). When I had the suprapubic catheter placed, my urologist also injected my bladder with botox, as I had powerful bladder spasms that also contributed to the large amount of urine that I was leaking. I'm hoping that with the spasms under control, intermittent catheterization may still be an option, as this seems to be the preferred method, albeit an inconvenient one. I know this post doesn't exactly help you, but I thought you'd like to know that you're not alone in this wet, stinky boat. If you have an issue with severe bladder spasms, you might ask your urologist for some information about botox therapy.
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  3. #13
    The bladder capacity becomes smaller and smaller and you nee to be on an anticholinergic such as Oxybutynin 10 mg three times a day and this might help prevent the lekaing in SPtubes and indwellings. The bigger the balloon the more room it takesup in the baldder and this is not the way to go. Even with Botox injections most who have had an indwelling tubein for a while will not get the capacity needed to do IC without leaking profusely so the bladder augmentation is an option. You need urodynamics while on Oxybutynin max dose after 2-3 months to see what your bladder capacity is and what the pressures are and the Bladder leak point pressure and then see the urologist. We also do the bladder augmentation using the intestine -not the appendix because you need the larger bladder to hold urine and the appendix is just used for a stoma to cath by.
    The bladder augmentation is Major surgery and several months post op care and management to do frequent caths and irrigations to slowly stretch the bladder, so you won't bust the stitches- and that takes a good 3-4 months after surgery.But it is a permanent fix!
    CWO

  4. #14
    Member Califanna's Avatar
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    Quote Originally Posted by SCI-Nurse View Post
    The bladder capacity becomes smaller and smaller and you nee to be on an anticholinergic such as Oxybutynin 10 mg three times a day and this might help prevent the lekaing in SPtubes and indwellings. The bigger the balloon the more room it takesup in the baldder and this is not the way to go. Even with Botox injections most who have had an indwelling tubein for a while will not get the capacity needed to do IC without leaking profusely so the bladder augmentation is an option. You need urodynamics while on Oxybutynin max dose after 2-3 months to see what your bladder capacity is and what the pressures are and the Bladder leak point pressure and then see the urologist. We also do the bladder augmentation using the intestine -not the appendix because you need the larger bladder to hold urine and the appendix is just used for a stoma to cath by.
    The bladder augmentation is Major surgery and several months post op care and management to do frequent caths and irrigations to slowly stretch the bladder, so you won't bust the stitches- and that takes a good 3-4 months after surgery.But it is a permanent fix!
    CWO
    Can you tell me what are they doing now for a urethra that is staying open? I was told by my new urologist yesterday that I should have a surgery where they put a sling using tissue from my leg. Ouch! I had been doing intermittent cathing but then boom, I started leaking so they inserted a foley which has been in for about a month. According to the urologist, I am holding about 150 - 200 ml but then I start leaking. Any new developments for women other than surgery of this kind?

  5. #15
    If your problem is that the angle of the urethra to the bladder is causing your incontinence, then a bladder sling like this is the most common procedure. Dacron should not be used. A muscle from your abdomen or leg is most commonly used.

    (KLD)

  6. #16
    Senior Member
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    Can you get to the Lahey Clinic in Burlington, or Peobody, Massachusetts? I see a urologist Dr. Mourtzinos there who is very knowledgeable (781) 744-8762. I would recommend him for a second opinion or surgery if need be.

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