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Thread: ? for SCI Nurse..re:sphicterotomy I had done.

  1. #1

    ? for SCI Nurse..re:sphicterotomy I had done.

    First,a little history... I've had C-6 Quadraplegia for 25 yrs. I have used condom catheter since.I had sphicterotomy in 92 and recently in Nov 2009, bladder wasn't draining well for a few mos.prior. 3 days after foley was taken out,drainage didn't seem to be much better, but drained well overnight while laying down. 1 week later I had to rush to urologist due to sweating and close to A.D. I had 400 cc in bladder, and 300cc in leg beg from just transferring from w/chair to table. I left with a foley in and been using since. I get a little leakage at times. Sun. night foley was changed,I was using an 18 fr, 10cc balloon. The next morning I had alot of leakage ,approx. 200-300cc, there was 2000cc in bag. I could see it leaking out around the foley. I had no where that amount of leakage the prior 2 mos.I had it taken out and put condom cath on. Drainage hasn't been as good as when foley was in. I can tell I'm retaining some but when I lean way over to the right or left I drain a little. Last night I was cathed before putting condom cath on,was 150 cc in bladder, but 150cc came out in 5 min.in leg bag from the time it took to transfer in bed from chair.
    Question #1..If I had a suprapubic done,what is likelyhood of urine leaking out the penis? If it does can that exit be somehow sealed up?
    #2 any idea why sphicterotomy didn't work? Dr. says prostrate is ok.
    #3 if I went back to a foley,will a 20 or 22fr reduce likelyhood of leakage? size balloon? My bladder does spasm some. which medicine can reduce spasms? is Enablex a good one?
    #4 My Dr. doesn't like to treat infections unless I'm having symptoms,like fever etc. can a mild infection cause bladder not to drain well using a condom catheter? It seems like,in the past,I start draining better after taking an antibiotic.
    My Dr. has talked about me having a diversion done, but I'm not sure I want to go to that extreme,I know there's no going back after something like that. I wouldn't mind just sticking with a foley for now if I can get the leakage under control. any longterm risks using a foley?
    Thanks for your time.
    p.s. This is a great forum for all of us out here,keep up the good work.

  2. #2
    Scar tissue can build up around the sphincterotomy and cause problems with drainage. Most urologist don't like to do sphincteromies anymore so you might have to push him if that is really want you want. The scar tissue wi have to be removed, there is also something called a uroume stent that mgiht coud be placed to keep your sphincter open and you would have to wear the condom catheter. They can do urodynamic testing and see what your leak point pressure is and with an SP tube if high, then the chances would be low.
    A bladder augmentation is a major surgery and you have to catheterize yourself in a continent stoma up on your abomen 3-4 times a day after it stretches to hold a arge amount.

    CWO

  3. #3

    response

    like I stated,I already had the sphicterotomy done in Nov. 2009, by a Dr. who has performed many of them,it looked like a good opening but it doesn't seem to be working,except when I'm laying down. I am following up with him but was curious of any info. you may have.
    Also, why would urine leak around a foley? spasms? what medicine works best to control this?

  4. #4

    re: stents

    I hear that stents aren't covered by insurance companys. are they a proven method to help drain? I'm 52, can calcium build up around it?

  5. #5
    stents have a really mixed success rate. easy to put in, difficult, if not a bit hazardous to get out. many migrate out of position. mine was still causing bleeding after a year and a half. mine never "skinned" over as supposed to. i think it was causing neurogenic pain for me. the installing doc, though i heard he was skilled, was deaf to my complaints, simply said the pressures were now ok.

    had to travel 4 hrs to an MD skilled in stent removal. at removal time he noted mine had migrated.

    at the time it seemed a logical conservative choice before perm indwelling or augment (urethral IC not an option). however, in retrospect i had lost, if you call it that, almost 2 years of difficulty which contributed to work place health issues.

    look at the literature on stents. the long term success % is prob not too high.

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