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Thread: Bowel & Bladder Control for High-Level SCI

  1. #21
    Quote Originally Posted by Joey_SF View Post
    Q: I've been reading posts and there's discussions about "leaking." My Dad does leak -- one time, this was the reason for 5 attempts for a foley change for the month. What is a leak indicative of?
    Bladder spasms and high pressures inside the bladder can cause leakage around the indwelling catheter, or between intermittent caths. This can be due the high pressure bladder, or due to spasms caused by UTI or just the constant irritation of the indwelling catheter.


    Quote Originally Posted by Joey_SF View Post
    Uh oh, the urologist didn't tell me to do anything "differently" and he did not prescribe any medication -- he said that we could continue with the foley. He shrugged a lot and was just very lackadaisical. He didn't talk about "high" pressure or about any long-term problems. During the urodynamics test, they had to stop the testing because at the 2nd round, my Dad's blood pressure went up.
    Doesn't sound like he knows much about neurogenic bladder due to SCI. Your father was having AD, a common occurance in high SCi during urodynamics due to over distension of the bladder.

    Quote Originally Posted by Joey_SF View Post
    The reason my Dad was referred was because the ER doctor couldn't insert the foley and used a dilator and guidewire, initially diagnosed a "penile urethral stricture" (is this another term for scarring?), and recommended the suprapubic.
    Urethral stricture is indeed an area of narrowing of the urethra due to scarring, usually from multiple traumatic catheterizations. A SP is both a way to prevent this, and to treat it. Was this not recommended by the "specialist" in urethral strictures above???

    Quote Originally Posted by Joey_SF View Post
    Actually, we were referred to another doctor, but she was fully booked. So, we were scheduled with this "younger" doctor who could schedule an appointment quite quickly. The coordinators also told us that this younger male doctor specialized in penile urethral stricture (the female doc was less "into" to this).

    I'll ask to see the more experienced female doctor -- since my Dad doesn't have this "stricture."
    How do you know he does not have a stricture??? Did the first urologist do a cystoscopy or a urethrogram (Xray)???

    Call the office and find out if she specializes in any area of urology, especially neurologic urology. If not, continue to search for another urologist who does.

    Quote Originally Posted by Joey_SF View Post
    So, the next step is:

    1) ask about the need for Oxybutynin
    Ask about the advisability of using an anticholenergic medication (there are a number other than just oxybutynin) to decrease bladder leakage, spasm, and pressures. The latter can be important with an indwelling catheter as this can lead to bladder reflux of urine up to the kidneys, which can cause bad UTIs, and damage the kidney over time.

    Quote Originally Posted by Joey_SF View Post
    2) schedule an appointment to check if my Dad can empty his bladder
    As discussed multiple times above, it is UNLIKELY that your father has voluntary control over urination with his injury, and using reflex voiding would NOT be advisable or safe, even with a sphincterotomy surgery. Keep the indwelling catheter, but consider a SP instead of the urethral type.

    Quote Originally Posted by Joey_SF View Post
    3) Straight cath options? any luck with electrical devices?
    If you have caregivers who are there 24/7, and willing and able to do straight catheterizations every 4 hours, and more often if he has high volumes or gets AD (emergently) and if he still has sufficient bladder capacity to hold 400 ml. of urine without getting AD or leaking, and is put on anticholenergic medications to prevent high pressures or leaking, then you might want to discuss this option with the new urologist. Since he cannot cath himself, he would need caregivers who can constantly available.

    The only "electrical" device for inducing voiding that are commercially available is the VoCare II (Brindley) bladder stimulator. Expensive (the device alone is nearly $20,000), requiring major spinal and pelvic surgery (also expensive) and requires cutting all the sensory nerves to the bowel, bladder and genitals. FDA approved in the USA only for those who are truely complete, and many people are NOT candidates. Urodynamics would have to be done to determine if he were a candidate, and then you would have to find a urologist who is experienced in the use of the Brindley (there are very few) and a hospital which has the required facilities. The hospitalization is usually 7-10 days. Not for everyone.

    (KLD)

  2. #22
    Senior Member
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    The doc said that if they were able to insert the coudre (sp?) catheter, this is indicative that my Dad does not have scarring -- because if he did have scarring, they would not be able to insert the catheter.
    Last edited by Joey_SF; 05-30-2013 at 06:36 AM.

  3. #23
    A Coude tipped catheter is usually used for getting past a big prostate, but it can also get through a stricture more easily. Just because you can pass one does NOT rule out having a stricture, but it is more likely that your dad is hard to cath due to external urinary sphincter spasms. Trying to force the catheter past a spasming sphincter is the most common way that false passages or urethral strictures are caused in men with SCI.

    (KLD)

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