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Thread: Managing Neurogenic Bladder with Chronic Foley use - help requested

  1. #31
    You do not have to remove a testicle to have an artificial sphincter (nor a pump-up penile prosthesis). The pump bulb fits in the scrotum right next to your testicle.

    A sling might be an option, but will make straight cathing more difficult, and it is still a pretty big surgery, esp. for men.

    (KLD0

  2. #32
    KLD - thank you SO much for the info. One last question - do you think this could be done by a general urologist ( like mine who has never mentioned this option to stop leaking) or would you go to a tertiary care center?

  3. #33
    arndog,

    have you tried to manually clamp your foley off so your bladder fills and then empty it when you need?

    I have done this with success for many years and I started doing it to enlarge my bladder to hold more than 75cc so I could transition to IC. I now hold ~350cc of urine before I need to empty my bladder.

    rick

  4. #34
    Senior Member canuck's Avatar
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    Arndog it might just be my preference but I would probably go to a terteriary care center, generalists re good for a lot of things but when it's something a bit more nebulous I would go straight to a big center and not miss around in what I call the "bush leagues"

  5. #35
    Clamping your bladder can be dangerous. It can cause the bladder to force urine up into the kidneys, and cause infections.
    please do not do t.
    ckf

  6. #36
    SCI-Nurse,

    I fail to understand how the clamped bladder and associated pressure is any different than the pressure of a full bladder between cath's. I can unclamp my bladder much faster than it takes me to cath.

    I know this is not discussed here in the U.S. but it is a topic of discussion elsewhere and for those interested they can visit 21ccp.

  7. #37
    That is a good questions and of course everyone is different . You need to have Urodynamics to see what your capacity (which can become very small with an indwelling catheter) is and what your resting pressure is and if you have a bladder contraction. Our Urologidst recommends everyone be placed on Oxybutynin or some type of low dose anticholinergic with an indwelling tube. While clamping the bladder might be okay the medication that relaxes the bladder is much more effective. Why did you have an indwelling placed after your SCI? This is usually not the first choice. So unless you ahve gained function.. the bladder was most likely an overactive bladder with a small capacity. And possibly high pressures and not safe for your kidneys but you might want to think back or look in to why you have an indwelling catheter in the first place. It is hard to go back to intermittent catheterization , not totally impossible but can be and depends on the situation and you need to consult a urologist to advise you. You do not want to get more infections or mess up your kidneys!
    CWO

  8. #38
    im not sure why I was put on indwelling cath other than my urologist didn't like that my bladder pressure was too much before I would void and my bladder would not empty all the way. I just lived with their decision but after many years of reoccurring uti's I attempted to go to IC but needed to cath when my bladder had ~75cc and that wasn't possible when working and playing rugby. I have heard of athletes inducing AD to get a performance boost but its not anything I felt was safe to do but I did start clamping off my extension tube just to see if I could slowly increase the amount my bladder could hold before I got the first symptoms of AD. after doing this for a year or so I was able to retain ~350cc before I needed to empty my bladder and I also noticed that my urine was much clearer and the uti's were rare. I only clamp off my bladder during the day due to the danger of reflux into the kidneys if I didn't wake up in time.

    sorry for the thread hijack

  9. #39
    KLD - I finally went to a tertiary care center, Stanford University Hospital, Palo Alto , Ca and saw Dr. Craig Commiter and had official video urodynamics done correctly. We talked about the AMS 800 device.
    Thank you for encouraging me to go - it was a 5 hour drive there from Reno.
    Dr. Commiter was great. I do indeed have a low pressure high volume bladder. After they subtract out abdominal pressure, I was at 15 mm of H20 pressure up to 700 cc. There is no external sphincter to speak of and leaking occurred with 100 cc while standing. With bearing down I could generate up to 120mm H20 pressure. So that is good news for my kidneys, there was no vesicoureteral reflux on imaging.
    It was great to have the test done the right way and not the walmart version at my local Urology office.
    Dr. Committer said I was a good candidate for the AMS 800. He does not think a sling is a good idea because without sensation, I wouldn't recognize if there was urethral erosion by symptoms of pain.
    So the AMS 800 can apply 70 mm H20 pressure. That means that if I lift weights or exercise, he still thinks I might leak through it.
    But it was great to get affirmation and confirmation about how badly I leak as an ambulatory paraplegic.
    I may do the operation in the late fall, after the Grand Canyon trip. He did say that I could place a foley in there if I locked the AMS 800 open.

  10. #40
    Great! Keep us informed about your progress with the surgery (and post some photos of your Grand Canyon trip too...I am jealous!).

    (KLD)

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