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Thread: New bladder management?

  1. #1

    New bladder management?

    Since my reflex voiding doesnt seem to work good anymore i need to change my routine. I would like to get a sphynctoretomy or a stent. I would like to stay away from ic. it gives me to many infections. Can people with stents or sphinc. chime in and give me some input on what is the good and the bad on these two options and which one would be the better choice.

    Thank you.....

  2. #2
    You may be able to continue to do reflex voiding a while longer if you have the outlet opened up with a stent or sphincterotomy, but there is no guarantee. If your bladder has already decompensated (lost the ability to contract well but with low pressures) the stent or sphincterotomy will not help much. With both of these procedures, you will be incontinent all the time, and must wear an external condom catheter all the time. Be sure you have no problems keeping one on. Now days, external sphincterotomies should be done with a laser (and not with a scalpel) so should have a low risk of loss of reflex erections (about 5% vs. 30%) if done by an experienced urologist. They can "scar down" though and may need to be repeated every 5-8 years. It is a fairly simple procedure done through a cystoscope. Bleeding is usually minimal when done with a laser. It should be considered a permanent "burn your bridges" type procedure, and it may be difficult to maintain a seal around an indwelling urethral catheter, and impossible to stay dry between intermittent catheterizations if you were to want to do those procedures down the road. A urethral stent (Urolume) is a wire mesh tube that is placed inside the urethra at the level of the external urinary sphincter, just below the prostate. It is down with a special cystoscope, and should be done by a urologist who has done this procedure a lot. The wire mesh is not sewn in place, so care much be taken to avoid dislodging it until urethral tissue grows through the mesh and secures it in place. This usually means no urethral catheterization for any reason (AD, etc.) for at least 3 months, and you may also need to change how you do transfers or bowel care (avoid having your perineum unsupported, or doing push ups that lengthen your torso). In theory, a stent can be removed later, although this is a very tedious and difficult procedure (each wire must be found, grasped, and individually pulled out). There is nearly zero risk of loss of reflex erections and bleeding with this procedure. We have seen them need to be redone if they shift out of place, and had a couple of patients who actually blocked theirs with excessive urethral scar tissue, requiring removal and a traditional sphincterotomy to be done. (KLD)

  3. #3
    Thank you for the very informative answer. Yes my bladder has lost some ability to contract. I did not know that the stent was removable after a length of time. I was told by my Dr. that the stent may of been discontinuned, any info on that. Does the bladder need to contract to empty with the stent.
    Thank you....

  4. #4
    My personal experience with the stent was not good. It was placed by an experienced urologist, and it has been confirmed by him and other urologists that the stent did not migrate and is positioned correctly, but it did nothing to help with detrusor sphincter dysynergia (DSD). As for being able to remove the stent, yes it can be done. But, unless you are having a tissue overgrowth problem or some other critical reason to remove it, you probably won't find a urologist who will remove it just to remove it. I've talked to 3 urologists about removing it. Before I got my suprapubic catheter, I went through a period of frequent and recurrent urinary tract infections. My infectious disease physician, for a time, speculated that the bacteria was "hiding out" in the tissues in the stent and he discussed removal of the stent with his urologist colleagues. None would consider removing the stent. I think today, many urologists are skeptical about the use of the stent and are very particular about screening to identify good candidates for it.

    When I had the stent placed, I discussed sphincterotomy with the urologist. At the time he would not consider doing it because it was not a reversible procedure, but I think times have changed and with refinement of this surgery with laser technology, more urologists will perform this procedure.

    All the best,
    GJ

  5. #5
    Yes, your bladder (detrussor) muscle still needs to be able to get urine out by contracting (reflex contraction) with either a sphincterotomy or stent, otherwise you would have to do intermittent cath or have an indwelling catheter.

    The Urolume brand of stent is still on the market. It is also used (with different placement) for BPH (prostate enlargement).

    (KLD)

  6. #6
    I started ic 4 times a day to get rid of the pressure until my next urologist appointement but after 3 days i got an infection. I do everything right and sterile. It is very frustrating and i really dont know what to do.

  7. #7
    My urine had a bad smell and there was a little blood so i started antibiotics, if i would of let it be i would end up at the emergency with a bladder full of blood. This is why i need to do something different to manage my bladder.
    To the SC-I nurse or anybody. What would my options be for bladder manegement?

  8. #8
    What has your urologist offered as options? I assume you have had urodynamics done? Generally your options at this point would be intermittent cath (with meds to keep you dry between caths if needed) and an indwelling catheter, either urethral or SP.

    (KLD)

  9. #9
    I have had urodynamics. I tend to retain 400-ml. We only talked about spynct. and stent. I insisted on that because of my problem with ic. and urinary infections.
    Thank you for the help.

  10. #10
    Did you have a urinalysis (UA) and culture & sensitivity before you started taking antibiotics? If not, it is likely that you are not taking the most effective antibiotic for the bacteria causing this particular UTI.

    What is level of injury?

    With a urine retention of 400ml your options would be:
    Simple--Intermittent catheterization 4-6 times a day, suprapubic catheter, indwelling urethral catheter.
    Complex (major surgeries)--Bladder augmentation with mitrofanoff procedure (catheterization through a surgically placed continent channel, Ileovesicostomy (surgical procedure that allows constant bladder drainage into a pouch worn on the abdomen-no catheterization).

    I was faced with having to change bladder management a few years ago. I had been using intermittent catheterization for a number of years, but frequent and recurrent urinary tract infections and the need to cath about every 2 hours (even with anticholinergics and Botox injections) forced me to try something else. I started by trying to wear an indwelling urethral catheter, while I weighed my options. I consulted a neuro-urologist in addition to my regular urologist. The neuro-urologist promoted the more complex surgical approaches. After a lot of discussion with my wife and our primary care physician, I decided to take the baby step of going to a suprapubic catheter. I reasoned that I could always take the bigger steps if the suprapubic didn't work out. The more complex surgical approaches are body altering procedures that are permanent.

    I have had the suprapubic for 3-1/2 years and my only regret is that I didn't do it sooner. Is it perfect? No. Do I get infections? Yes. But with the use of Vetericyn VF, I've had less than a handful in this time (some people have been infection free since they started using Vetericyn).

    All the best,
    GJ

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