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Thread: Bladder Pressure Criteria Questions for Nurse or Dr Wise

  1. #1
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    Bladder Pressure Criteria Questions for Nurse or Dr Wise

    I am a 59 yr old C1/C2 who has had a very good recovery. I can walk ten miles, ride my bike 80 miles and I have pretty good bowel and bladder. After four weeks in ICU and CCU, Upon entering rehab, they removed my catheter, and I have been voiding voluntarily for five years. Lately I have been cathing once a month to monitor my post void residual. This month I voided 300 ml and had a residual of 100 ml. Recently my Urologist gave me a kidney ultrasound and a urodynamics test. The ultrasound showed no problems, but the urodynamics result was 86 cm h2o peak pressure, 52 cm h2o mean pressure, and 14 cm h2o pressure at peak flow. He is recommending that I start using Ditropan, and, if that prevents voluntary voiding, that I do intermittent catheterization. I am hesitant to do that. My questions are:
    Which pressure, mean or peak, should be evaluated?
    How high will cause kidney damage?
    I would like to read the research that shows this. Can you cite a paper?

    Thank you so much for your time.
    C1/C2 walking quad, SCI from 4/2010

  2. #2
    We have known since the mid-1980s that high pressures in the bladder put the kidneys at risk, and also increase your risks for UTI. The "magic number" is 40 cm H20 pressure. The reason this is the secret number is that is the pressure with which the ureters propel urine down the ureters into the kidney by peristaltic wave muscle action. If the pressures in the bladder are higher than the pressures in the ureter, back-pressure is exerted on the kidney, which ultimately can kill of kidney cells (nephrons) and increase your risks for renal failure.

    Standard of care is for you to have had urodynamics 6 months after injury and then every 1-2 years afterwards if you have a SCI, even an incomplete injury. Your bladder can change over time, and higher pressures can develop due to changes in the bladder muscle with denervation, or because of incoordination between the bladder muscle and the sphincter muscles (DSD = detrussor-sphincter dysynergia).

    Your urologist recommendations are sound, and current with state-of-the-art practice for management of high pressures in those with SCI.

    Here are just a few articles about this:

    http://europepmc.org/abstract/med/2724437

    http://europepmc.org/abstract/med/8426179

    http://europepmc.org/abstract/med/1732606

    http://www.jurology.com/article/S002...abstract?cc=y=

    http://onlinelibrary.wiley.com/doi/1...+inconvenience.

    http://www.jurology.com/article/S002...800-7/abstract

    http://www.researchgate.net/profile/...d087cdc7e6.pdf



    You will notice the mention of "compliance" in some of these articles. The concept of bladder compliance is the normal ability of the bladder to stretch to accommodate fairly large amounts of urine without increasing the pressure in the bladder. Non-compliance or low compliance then is another way of expressing the concept of a high pressure bladder seen in those with a neurogenic bladder.

    (KLD)

  3. #3
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    Ditropan experiences and voiding

    I have been voluntarily voiding for 5 years sInce one month post SCI. My Urologist is now recommending that I use Ditropan for high bladder pressure. He also said that this my stop my ability to void voluntarily and that I would then need to use intermittent catheterization. Have any of you gone through starting Ditropan. Did it change your ability to void?

    Thanks for your time.
    C1/C2 walking quad, SCI from 4/2010

  4. #4
    See my response above to your similar question of yesterday. Yes, it can change your ability to void, but this may be needed to get your pressures into a safe range. Adjusting the dose of the anticholinergic you are using may allow you to continue to void, but urodynamics must be repeated on the meds to see if this is safe.

    (KLD)

  5. #5
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    Sorry, I meant to start a new thread asking the SCI patients about their experiences. Thanks for your reply.
    C1/C2 walking quad, SCI from 4/2010

  6. #6
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    Ditropan questions

    I have been voluntarily voiding for 5 years sInce one month post SCI. My Urologist is now recommending that I use Ditropan for high bladder pressure. He also said that this my stop my ability to void voluntarily and that I would then need to use intermittent catheterization.

    Have any of you gone through starting Ditropan. Did it change your ability to void?

    I'm thinking about trying it, and stopping using it if it changes my ability to voluntarily void. Do you see any problems with this?

    All replies are appreciated. Thanks for your time.
    C1/C2 walking quad, SCI from 4/2010

  7. #7
    I combined these three threads since you are asking the same question or addressing the same issue. It helps to keep the information together and avoid having to respond in multiple threads. I assume you mean people living with SCI, not patients.

    (KLD)

  8. #8
    I had been on 15 mg extended release Ditropan for a couple of years while intermitting cath since the day of my accident. Starting about 6 months ago I was having problems getting cathed in time before I would have an accident. From the time I started to get a tingle in my head until I had an accident was about 45 seconds. I had a couple of visits to two different urologists because I was not only leaking, but once the catheter entered the bladder the urine came out under pressure. To address this the last urologist I met with had me increase my Ditropan from 1, 15 mg tablet to 2, 15 mg tablets, one every 12 hours. This increase in Ditropan took care of the problem of having accidents because I couldn't cath fast enough. It has also reduced the pressure my urine was coming out at. Other than the terrible dry-mouth and dry sinuses, this has taken care of any of the problems I was experiencing. Moving forward my urologist would like to replace the Ditropan with a Botox shot into the bladder. I'm looking forward to this so I can get rid of my dry-mouth issues now.

    Take care.
    DaDutchman
    C5/C6 since 2007 due to car accident

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