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Thread: Urodynamics question for the good doc or nurses

  1. #1

    Urodynamics question for the good doc or nurses

    Quote Originally Posted by quadvet
    Are you saying people with SCI should have a cystoscopy on a regular basis like this? And how often should urodynamics studies be done?

    Thanks much CWO.
    This was embedded in another thread, and I thought it was a good question and might get missed there.

    Meanwhile, I have my own question about urodynamics. I am a C3/4 incomplete, central cord syndrome, S/P 12 years with substantial recovery. I was cathing, or should say, being cathed (still had insufficient hand function, they were training my hubby to cath me), for the first seven weeks, while I was in rehab. My bladder returned two days before discharge, it was actually what prompted my insurance to finally kick me out. I presume the spinal shock was wearing off, my fingers were just starting to get return as well. They did two or three tests on me after self-voiding before I left rehab, all which showed I had less than 50-100 cc residual, so I was discharged with no caths (gee, shucks).

    The first couple of years there would be periodic times I could feel I was suffering from retention, but I ignored it. Eventually my bladder would empty, if not one voiding or the next, maybe three or four voidings later, tops (and generally the voidings were frequent then). A couple of times I almost went to the ER early on, unable to void at all, but at the last minute, my bladder would finally cooperate. I also was getting UTI's about once a month. My neurosurgeon put me on prophylactic antibiotics and that was the last of the UTI issue. After a couple of years, the retention stopped being an issue, instead being replaced by urge incontinence (if it isn't one thing, it is another). I stopped the antibiotics, still no UTI's since, don't expect any, no retention, not cathing. This is where I remain now, and I use Detrol LA to help control accidents, as well as not allowing my bladder to get too full (unless I feel like living dangerously).

    At no time have I ever had urodynamics nor has anybody suggested that I have them done. My SCI physiatrist discharged me after about 18 months, deciding to devote his practice to stroke patients instead. The only other SCI physiatrist in town I didn't care for, I saw her a lot while I was in rehab, she was the other attending on the unit. So instead I followed up with my neuro who was treating my migraines, who is not only a real sweetheart, but positively a brilliant physician (everyone in the medical community would agree, he is the doctor that doctors see). And with all the research I have done, much on this forum, the expertise he demonstrated was on par with any SCI specialist, except for perhaps our own sage Dr. Wise.

    I did ask him once, maybe five or six years post, after reading about urodynamics on this forum, if I should have them done. He said he would make the referral if I liked, but no matter the results, the treatment would remain unchanged so he didn't feel it was necessary. Since urodynamics don't sound like my idea of a fun way to spend the day, I was more than happy to drop the matter.

    So, finally.......... here is my question. Does somebody like me really need urodynamics (the desired answer would be "no")? And if not, what is the criteria for who needs them and who doesn't? Only those who are cathing? Or those who are cathing and/or have retention issues? I have read the bladder management guidelines and was unable to find a definitive answer. And as quadvet asked, if one does need them done, how often should they be done? And finally, exactly what kind of tests need to be done?

  2. #2
    One of the reasons we do Urodynamics with
    VCUGs(video fluoroscopy) & EMG to actually know what is going on with the bladder, urethra and sphincter & prescribe treatments and medications. But another main reason is to check bladder pressures- as it fills, with contraction and when the voiding occurs. The only way to do this is to have urodynamics to test the pressures before any kidney damage occurs. Years ago, it was common for people with SCI to have kidney damage, need dialysis and die from kidney failure.

    Also, even with checking post void residuals and getting a good bladder history, urodynamics can show a totally different picture of what is expected ;ther times it shows exacty what the patient already told us was going on.
    So, I think you (& everyone who has voiding difficulty) should get urodynamics for a baseline & if everything is great you might not need them again or maybe every couple of years. Others -really need it yearly or atleast every other year.

    Re: indwelling catheters & SPTs- after 5 years of continuous use-it is recommended to have cystoscopy (and can have bladder washings with this) every year or every other year because of the 10% increased (10%)risk of developing bladder cancer.

    CWO

  3. #3
    Thanks for asking this, Dunwawry. I've only had urodynamics study ordered twice since my injury in '90, only for diagnostic purposes, didn't know it was a maintenance thing. Had indwelling catheters 12+ years, urethral and suprapubic.

    Now I have a urostomy...was it necessary, could the problems have been detected and solved earlier on. How much damage was done to my kidneys over so many years of high bladder pressures??

    Got a loopogram and CT scans of my abdomen and pelvis scheduled this Tuesday. Complaints of kidney pain, already treated with antibiotics per doctor order, without relief. Sure scared for my kidneys...
    Last edited by quadvet; 02-11-2008 at 08:00 AM.

  4. #4
    Senior Member
    Join Date
    Aug 2006
    Location
    Spring Hill , Florida
    Posts
    616
    QUADVET:
    I'm also a Veteran. Thank you for serving. Sorry to hear that you suffered a SCI. Are you service connected for SCI?

    Question: You mentioned suprapubic catheter which I have. What prompted you undergoing urostomy surgery? What do you think of having a urostomy? It's some thing I've been thinking about. Having the catheter changed once a month at the VA I go to is a pain in the neck & time consuming. I've heard that indwelling catheters can possibly cause bladder cancer. I did'nt know that before I had the suprapubic catheter surgery in February 2005. Tried intermittent cathing & several different kinds of catheters use to cause me to bleed some from penis.

    Any advice or suggestions you could post would be most welcome

    Fellow Veteran,
    Robear
    Trached 2/87
    Vent for Sleep 12/98
    Suprapubic Catheter 2/05

  5. #5
    Thank you CWO for answering my question, even though I didn't like your answer. Hmmmm, have to ponder on it a while.

    Good luck with your testing quadvet, hope all turns out well.

    RAFS,
    Having a trach and being on a vent, aren't you eligible for in-home skilled nursing care? You are exactly the type of patient the agency I work for specializes in, and those who were injured before the mid-90's or so (whenever the Medicaid/Medicare changes kicked in) get 24/7 care. And we routinely will change out the suprapubic caths, as long as we have a doctor's order to do so, which unless there is some problem or it is brand new, we do. It would save you the monthly trip to the VA.

    God bless you both for being there to serve our country.

  6. #6
    dunwawry,

    I think that you have answered your own question. Use common sense. If you have recovered and have been peeing on your own without any problems, you don't need urodynamics. However, if you are leaking, having urinary tract infections, or have retention, you should have urodynamics to find out what is going on and to document your bladder function. I have recommended here that anybody who is catheterizing or taking bladder anti-spasticity drugs to get urodynamics regularly. Since you think you may be retaining, I think that you should consult a urologist. The extent to which you need urodynamics done on a regular basis depends on whether any abnormalities are found and you are receiving therapy.

    Wise.


    Quote Originally Posted by dunwawry
    This was embedded in another thread, and I thought it was a good question and might get missed there.

    Meanwhile, I have my own question about urodynamics. I am a C3/4 incomplete, central cord syndrome, S/P 12 years with substantial recovery. I was cathing, or should say, being cathed (still had insufficient hand function, they were training my hubby to cath me), for the first seven weeks, while I was in rehab. My bladder returned two days before discharge, it was actually what prompted my insurance to finally kick me out. I presume the spinal shock was wearing off, my fingers were just starting to get return as well. They did two or three tests on me after self-voiding before I left rehab, all which showed I had less than 50-100 cc residual, so I was discharged with no caths (gee, shucks).

    The first couple of years there would be periodic times I could feel I was suffering from retention, but I ignored it. Eventually my bladder would empty, if not one voiding or the next, maybe three or four voidings later, tops (and generally the voidings were frequent then). A couple of times I almost went to the ER early on, unable to void at all, but at the last minute, my bladder would finally cooperate. I also was getting UTI's about once a month. My neurosurgeon put me on prophylactic antibiotics and that was the last of the UTI issue. After a couple of years, the retention stopped being an issue, instead being replaced by urge incontinence (if it isn't one thing, it is another). I stopped the antibiotics, still no UTI's since, don't expect any, no retention, not cathing. This is where I remain now, and I use Detrol LA to help control accidents, as well as not allowing my bladder to get too full (unless I feel like living dangerously).

    At no time have I ever had urodynamics nor has anybody suggested that I have them done. My SCI physiatrist discharged me after about 18 months, deciding to devote his practice to stroke patients instead. The only other SCI physiatrist in town I didn't care for, I saw her a lot while I was in rehab, she was the other attending on the unit. So instead I followed up with my neuro who was treating my migraines, who is not only a real sweetheart, but positively a brilliant physician (everyone in the medical community would agree, he is the doctor that doctors see). And with all the research I have done, much on this forum, the expertise he demonstrated was on par with any SCI specialist, except for perhaps our own sage Dr. Wise.

    I did ask him once, maybe five or six years post, after reading about urodynamics on this forum, if I should have them done. He said he would make the referral if I liked, but no matter the results, the treatment would remain unchanged so he didn't feel it was necessary. Since urodynamics don't sound like my idea of a fun way to spend the day, I was more than happy to drop the matter.

    So, finally.......... here is my question. Does somebody like me really need urodynamics (the desired answer would be "no")? And if not, what is the criteria for who needs them and who doesn't? Only those who are cathing? Or those who are cathing and/or have retention issues? I have read the bladder management guidelines and was unable to find a definitive answer. And as quadvet asked, if one does need them done, how often should they be done? And finally, exactly what kind of tests need to be done?

  7. #7
    Welcome aboard, Robear, took you long enough to post. Sorry you had to come here under these circumstances. Thanks, and thank you too for serving.

    To answer your question as to why I have a urostomy, my bladder shrunk so tightly as to block the urine from exiting the holes in the bladder end of the catheter. That created back pressure against my kidneys, requiring enough urine to build up in my bladder to open the holes to release the urine. That pressure, or bladder reflux, causes all kinds of problems, not the least of possible permanent kidney damage. Symptoms that led to urodynamics and diagnosis was constant mid-grade autonomic dysreflexia, and significant pain.

    It's not a surgery I would go for without real reason, tougher than colostomy surgery. Caring for both ostomies are about the same, not that hard. Also, the docs at the VA warned me that urostomates aren't expected to live more than 25 years after the surgery.

    As to your situation, yes, indwelling catheters can cause lots of problems. Intermittent cathing is always the preferred method, if at all possible. I suggest talking to a urologist and asking for urodynamics study to determine bladder volumes and pressures. If you can go back to IC, I found the softest and least painful catheter is latex, if you can still get it from the VA.

    Are you spinal cord injured, I should've asked that first.


    Hopefully, others may have further insight.


    Thanks for your post, Dr. Young, this is hardly a question I can give a general answer to.
    Last edited by quadvet; 02-13-2008 at 06:22 PM.

  8. #8
    Okay, now I am confused again, Dr. Wise. I do NOT think I am retaining, not for the last 10 years or so, but AM taking bladder antispasticity meds, i.e. Detrol LA., for urge incontinence. But my common sense says I don't need any testing, since I don't consider the urge incontinence any REAL problem. So I guess I should go with that?

  9. #9
    As mentioned, the frequency of urodynamics depends on your symptoms and method of bladder management ( e.g. people with indwelling catheters don't need urodynamics done if their catheter is draining properly).

    You don't mention if you are having any symptoms of your urge incontinence that is not controlled with your Detrol. If os, that would be an indication that you would want to further pursue urodynamic studies.

    Clinicians are different in their recommendations but in practice I would say most people recommend a baseline urodynamic study and then determine frequency based on pts condition and symptoms.


    AAD

  10. #10
    Thank you so much AAD, that clears it up for me. And yes, I still have symptoms (accidents) even with the Detrol, they are merely less frequent than if I don't use Detrol. I find it hard to complain though, considering the alternatives. I COULD be still cathing, like most here. And given that the alternative to me continuing as I have, as revealed by the results of urodynamics, is to go back to cathing at least part time, makes me even more reluctant to pursue any testing. You all were "supposed" to tell me I didn't need it.

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