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Thread: Urologist Confict - Third Opinion?

  1. #1
    Senior Member mjschaef's Avatar
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    Urologist Confict - Third Opinion?

    Hi all. I'm T-6 since August 27 of this year. I just had a second urodynamics test done today by a different urologist than the first test...

    The results could not have been more different, and I am now very confused. The tests were only two months apart, and I no longer know what to think. I switched all of my doctors after my inpatient care, and have had all of my tests re-done. This is the only one that is weird.

    The first test showed great(low) internal pressure, and my residuals have always been low (<150 cc's). I was put on Flomax to help keep my bladder open, and use an external catheter to collect the urine.

    My new test (done today) shows heavy internal pressure, but my residuals are still low. The new doctor wants me to start an intermittent cath program along with Detrol.

    So, you can imagine that I am a little confused. First, I am not sure why a doctor would want me to retain more urine, and I am not sure why it would be preferable to cathing... Plus, why would there results be so different in just a few short weeks?

    Should I get a THIRD opinion? Any help would be appreciated.

    --------------------
    "On November 2 the voice of the people was heard. I promise not to imitate it out of respect for the mentally retarded" - Lewis Black (Comedian)

  2. #2
    Senior Member mike's Avatar
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    I have a similiar problem. My first urodynamics showed fairly high pressures and the second test showed pressures that were fairly normal until my bladder was filled beyond 400ccs. In both cases I had low retentions,below 125ccs. One doctor wants me on ditropan and the other wants to watch the problem for a while. I think I will get another opinion as up until now I did not have to cath or take any medication and now I am being told that things have changed after five years. Very frustrating.

    mike

  3. #3
    It seems to me the goal or outcome would be different. Is the doctor, (and are you) interested in not using the external catheter? That would be one of the reasons for his recommendations. I would talk with the doctor again to discuss his plan/recommendations. Maybe you weren't in sync with the same goals.
    Whatever you decide, you are correct in keeping the internal pressure low, low residuals and never having more than 400ccs of urine in your bladder.

    CWO

  4. #4
    What about a bo-tox shot. I was thinking maybe this could help me. I have anb external cather and also had the sphincter muscle cut in 1990. I am not necessarily having much bladder pressure, but I am thinking if the urine flowed out easier as I sit on the commode chair, then this would continue to keep me uti free. I usually pee better as I do a bowel program. This may change if I get a colostomy so I am trying to figure out how to keep empty without cathing. It does not help me to cath any. I know bo-tox can relax the sphincter but I don't know if my sphinter would benefit since being cut. I was wondering if a bo-tox might help me to drain better. I am not sure how a bladder sphincter works. I thought I remembered reading a little about two muscles in the "whatsyoumaycallit" and only one is cut. I have no idea.



    David


    ~ Elvis has left the building ...

  5. #5
    mjschaef, bladder spasticity is like leg spasticity. It varies depending on the time of the day, it fluctuates over time, it is influenced by the drugs that you take, and it can be aggravated by irritation (i.e. decubitus, pain, etc.). The difference between your first and second urodynamics is, however, unusual. I am wondering if the test was conducted differently? What are the differences in the pressures? Instead of using adjectives, you should find out the numbers, the type of test, and volumes involved.

    Regarding why a doctor would want you to "retain more urine", the reason is bladder volume. When you have a spastic bladder that contracts with even with small volumes of urine, you end up with a small bladder with little capacity. Keeping the urine in the bladder to expand the bladder is a standard approach for increasing bladder capacity. If you are automatically voiding, drugs may help slow that down. But, if you take drugs that inhibit voiding (most anti-spasticity drugs do that), you then need to cath.

    I am not sure what you don't understand and so please ask further questions if I have not answered your questions.

    Wise.

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