Flunked my urodynamic test

I read your post in this seems you need to get a new uro. I get my care with the VA affiliated with a large medical school. Since last April I have had a prostate 3T MRI, cystocopy and the urodynamic testing all ordered by the MD's in the urology department.

I know that Medicare and private insurance has restrictions on what diagnostic tests can be ordered and how often but that does not sound like whats is going on in your case.

If you can afford it there should not be any problem finding another urologist willing to order any procedure you request.

I start to think I have a bad medical group. I am thinking about filing a complaint but not sure that it would be wise. Will I feel comfortable having someone treating me, sticking something inside me, after the complaint ?

About your urodynamics test, I wonder if it was not done correctly. You said it showed you have no obstruction. You can verify this when you are cathing, right ? What size of catheter, what type, what size, how easy you slip it into your bladder can confirm if you have obstruction or not.

Hank

Also, did you have a cystoscopy ? Did it show no obstruction ? Hank

Had a cystocopy last June. Here is the part of procedure note talking about obstruction:

"A 17-French cystoscope inserted into the urethra.  Normal urethral mucosa was encountered.  Scope passed easily past the enlarged prostate into the bladder.  No strictures were found.  No bladder neck contractures werefound. Bladder was then surveilled in a uniform fashion.  No masses or foreign bodies.  He does have multiple trabeculation.  He has multiple diverticula."

I use a Speedicsth 14Fr Coude. I was using the straights when I first started and occasionally had problems entering the bladder especially when it was full. They switched me to the coude's and they work well.

So if the cystocopy shows no obstruction and the urodynaamics test shows no obstruction, for me anyway, I have to accept there is no obstruction and the retention is caused by a nuerogenic bladder.

As far as your case is concerned, if it were me I'd find another medical group...

I didn't see any thing from the cystoscopy that indicates no obstruction. No strictures yes. Full or not, the fact that you had problem with fr14 straight makes me think you have obstruction. Maybe not too bad an obstruction. Hank

LOL

I don't the problems with my docs that you have with yours so when they tell me there is no obstruction I believe them. I'm happy with the course of treatment they recommend and I don't mind doing CIC so it works for me.

Everyone is different I think the best anyone can do if find out what works for them and go for it....good luck I hope you find a new medical group and the treatment that works best for you.

😁 Hank

It's supposed to work the other way around. You get the tests to diagnose the problem so that they can treat it by more than guessing. Anyone that would do ANY procedure, especially a TURP without any kind of diagnostics is a money hungry butcher. No testing until after major surgery? Should be reported to the state medical board and AMA.

I would run away from this doc.

Thanks Buzz. Did you see my recent discussion regarding this issue "My disappointing urologist visit" ? Hank

No - I missed it

Here it is

https://patient.info/forums/discuss/my-disappointing-urologist-visit--612836

Hank

Here you go, this is from last month don't keep very close track anymore

8/10/17 2:00    250    

8/10/17 4:50    475    Catheter    

8/10/17 8:00    100    

8/10/17 9:10    180    

8/10/17 11:20    270    Catheter

8/10/17 13:00    180    

8/10/17 17:20    400    Catheter

8/10/17 20:30    120    

8/10/17 21:17    80    

8/10/17 23:10    150    

8/10/17 23:55    580    Catheter

Total 8/10/2017    2785   

Looking at them now I guess the catheter voids have been creeping up since I started last October.

 

 

Hi JW,

Unless I'm looking at your log wrong, it doesn't seem you cath immediately following each natural void (NV)? Is that correct? If so, is this the way you have always done it and why? Normal protocol is to do a NV (if possible) first, then self cath right after. This not only helps clear the urethra of bacteria, but tells you the PVR (post void residual). 

Jim

Hi jw, your log looks almost like mine, except I try to keep the total below 2000ml. If your bladder is shot, so could be mine. 😥 Hank

Hi Jim

I used to try to have a NV before the self cath but it was always less than about 80ml and usually nothing and took forever so what I have been doing lately when I have bothered to measure is just try to measure it every 6 hours or so. It seems that I can have a NV if the volume is about 200cc's or less if I wait long enough but when it gets much higher than that the bladder locks up.

I've noticed that, for me at least, being able to completely empty the bladder with CIC is the reason I keep doing it, so I don't screw around with trying to measure a small volume that takes forever to produce first.

I've kind of accepted that this (CIC) is the way its going to be for the rest of my life so I just do it and like I say knowing I have completely emptied the bladder, thus keeping the kidneys healthy, is kinda self reinforcing.

So those numbers are pretty accurate except they don't show the couple of times a day I might try and get nothing. Usually, if I'm not on the road, I'll just self if I try and nothing comes out.

Joe

Hi JW,

I mean something different. Take for example, these log entries with you have a decent NV. Why didn't you cath right after those NVs? 

Again, if you are able to have natural voids, which you are, I would set up my cath schedule as follows. First do your natural voids based on urge. Void then cath. If the total bladder volumes (void and cath volume) are mostly below 400ml, then continue on. If they are above 400ml, then first try scheduled natural voids (on the clock as opposed to having an urge) and again measure total bladder volumes. If they are now under 400ml, keep that cath schedule. If they are over, now start throwing in some scheduled caths without natural voids until total bladder volumes are under 400ml.

Jim

8/10/17 2:00    250     

8/10/17 8:00    100    

8/10/17 9:10    180    

8/10/17 13:00    180    

Ahhhh I get you....I'll give that a try.

Basically your saying keep it to below 400ml and see if there is an improvement.

Thanks

That's part of it, yes. With your method, you won't know either your PVR or total bladder volume. That, plus you're not cleaning out your urethra with urine prior to cathing which is ideal. Let me know what your log looks like when you NV first and then cath. 

Jim

Actually I used to do it that way back in April

4/18/17 0:20 50

4/18/17 0:21 210 Catheter

4/18/16 6:27 240

4/18/16 6:27 225 Catheter

4/18/17 8:35 80

4/18/17 11:00 175

4/18/17 11:40 100

4/18/17 11:40 150 Catheter

4/18/17 14:45 150

4/18/15 17:00 150

4/18/17 18:40 100

4/18/17 18:40 150 Catheter

4/18/17 22:15 125

4/18/17 23:45 150

Total 4/18/2017 2055

Your bathroom trips and number of caths per 24 hours are approx the same either way. So why did you switch? My suggestion is to cath after you void whenever possible, as long as total volumes stay below 400ml. That doesn't mean you cant cath without voiding from time to time due to convenience.

Jim

I switched because I just figured why do it twice? I've gotten pretty good at almost completely emptying the bladder with CIC.The ultra sounds they have done show only 5-15cc left after I self cath.  Seems if I can almost completely empty the bladder when I self cath why take the extra time to do it twice...

Also when I could not void during the test they used 767 as the PVR. Because I self cathed  right after and that's what went in and came out. Are they using a different method of calculating PVR?

As long as your total bladder volumes don't fall below 400ml, I guess no great harm orther than in theory your chance of a UTI is less if you void just prior to CIC. But if UTIs are not an issue, and you periodically check your total bladder volumes by voiding before your cath, then again no harm.

Jim

Jw, your April void did not look bad. You were able to natural void quite a bit. Were you on meds at the time ? Do you think you can still void like that now ?

Hank

Things seem to have gone hill since April even though I've been on Finasteride the whole time and the size of the prostate has shrunk. I drink  lots of iced tea during the day and that seems to help but at night and early morning I can't go or only a a small amount and I cath.

I 'll probably do that and if I have a NV in the 200-300cc range I'll self cath to see how much is left. I want to keep doing NV as long as possible.

I don't seem to have a problem with UTI's the only one I have gotten afer the first few weeks  is when I had to use a catheter I dropped on a public restroom  floor ...always make sure I have enough catheters with me when I'm on the road now...

 

How long have you been doing CIC now? Have you read my thread on the "on/off" method of bladder retraining?

Jim

Started  both CIC and the finasteride last October.  I read the on/off thread awhile back I'll have to revisit it.  I'll eventually lose the ability to have a NV at all due to my continuing neurological decline but I figure doing things that may slow down the inevitable can't hurt...

I had forgotten you had neurological issues. If it affects the bladder than not too much you can do. Fortunately, CIC will work just as well whether the nerves work or not. Many in the SCI (spinal chord injury) community (as well as some others) never have natural voids and they do just fine with CIC. 

Jim

There is a forum thread on here, in which some posters mention drinking coffee at dinner time, to help minimize the urge / nightly bathroom visits.

Is worth a try to drink decaffeinated tea during the day instead, that might help you urinate more?

I may have started that thread, but I suggested the coffee (caffeine) earlier in the day for its diuretic effect. That said, experiment. Things work differently for different people. 

Jim

Have you ever tried running your fingers through very cold tap water, when having problems in starting to urinate?

Science behind it explains the body's triggered reaction to expel fluids, to conserve core heat. 

Wondered if you or anyone else has tried it during your experiences.

Never tried it but easy enough to do. Not sure if qualifies, but there is something called "reflex" voiding where you tap or rub various parts of the body to stimulate the voiding response. I use tapping on occasion.

Jim

I tried it and it MAY have worked. Thanks for the tip, I will experiment more. Some quick research suggested warm water might also work but the principle is different from the one you report. Do you have a link to the science behind it? I might try ice water next.

Jim

Hi Jim I would like to try this expeirment ,cold water. Could you explain in more detail how to do this?

Thanks

frank,

Hi Frank,

I was just about to post to you on this very subject! So it's really pretty easy to do, especially if the sink is within arm's reach of the toilet. If not, I would then stand next to the sink and try voiding into a cup or container. Just run the water as cold as it will get over your fingers (or entire hand) and see if it can void. I tried it a couple of times and it sees to stimulate the detrussors as your body temp gets lower. It's almost a shivering type of sensation you want to get. No harm in trying it. 

Jim

I would give it at least a few minutes because the idea, I think, is to lower your body temperature. Credits go to "self help" for pointing this out but further research shows similar techniques on web sites for pregnant women who apparently also have voiding issues. For some reason, I never visited the pregnant women web sites. Go figure.

Jim

Jim, Is this Spanner SRS Medical ,the same thing you were talking about?This is a stent this is put in the bladder.Is this the procedure that would tell if your surgery would be sucessfull, that one would be able to urinate ,normal void?

Confusing to me.

Thanks  jim,

frank

Hi Frank,

I thought you were talking about the "cold water" experiment. This has nothing to do with the spanner stent. Not sure what your question is. 

Jim

I'm wondering if in addtion to stimulating the detrussors, if the cold water could possibly also shrinks/reduces inflammation of  the prostate temporarily allowing for a better void. Sort of like it might shrink your manhood per the funny Seinfield episode. I did notice when I put my hand in the cold water that I got a slight shiver so that the heat was definitely leaving parts of my bod. Just thinking out loud. Still can't say for sure it's working, as I've only tried it a few times, but I think it might be. 

Jim

Jim , You had said if a stent was put in your uretha,but not in your bladder,then if i could pee then its the obstruction,enlarged prostate thats the problem,not the bladder, and surgery would be successful.Am i explaining this right?Is the spanner stent different than this stent?Educate me?

Thanks Jim

frank,

You are right in concept. The problem is that the Spanner stent doesn't exactly duplicate an open urethra, because the Spanner goes into the bladder where it is held in place with a balloon device. Still, in theory, it could give you a "preview" of how your bladder might function with a prostate reduction surgery. The challenge is to find a doctor who will use the Spanner this way. You might inquire about this to Jersey Doc, who I believe uses the Spanner, although not sure how often he uses it this way.

The cold water thing is entirely different. You might try it when you feel an urge to void and see if it can produce a natural void. Just run the cold water, as cold as you can get it, over one of your hands while you try to void. Give it a few minutes and see if anything happens.

Jim

Cold water update...

I'm pretty sure something was going on. I had overhydrated earlier in the day and that usually meant I might run into a problem voiding. The cold water trick seemed to override the problem and allowed several voids I might not have been able to make as easily as without it, or perhaps not at all. So that was the good news.

The bad news, and it very could well be coincidental, is that after my third or fourth "cold water" void, I started to get a burning sensation. So, again, either coincidental, or let's call it my cold water inhanced void, was a little too much for the ole' prostate and/or urethra. I dropped off a urine culture this morning and have antibiotics on stand by. For now, I will keep my hands out cold water but there's something definitely there. 

Jim

As I wrote, science says that when the body is exposed to cold temperatures, it invokes a defensive mechanism to protect the body's core temperature ? Release fluids.

When individuals are experiencing problems urinating, there becomes a fine line between anxiety and need. Question arises if one really needs to go, or are they just overreacting nervously?

The cold water trick helps to stop the anxiety of " do I have to really take a p**s", versus starting the urination process. It's a much better solution than one staring at their equipment for countless minutes, wondering if they have to really go. 

Once one becomes familiar with their body's reactions, the stress is removed and the procedure is over with quickly. The time your fingers are placed under the cold water (colder, the better), will depend on your body's reactions ( 15 seconds - 2 minutes).

Note that this was discussed earlier in time ? ""Cold-Induced Diuresis was first observed over 200 years ago by Sutherland (1764)"

How about holding cold ice in your hand ? Hank

I've read several different theories why this might work (or not work), but it seemed to work for me. Problem was, as I explained earlier, was that by supercharging my aging motor (detrussors) in my aging car (bladder) I might have irritated the prostate and/or urethra. Right now I have a burning sensation and am taking d-mannose with antibiotics standing by. No more hand in cold water for me right now!

I am now confused. How can a cold hand open up you urethra or prostate restriction and let you urinate ? Hank

? "When an area has more sensory neurons there is a larger brain area devoted to receiving their signals, meaning more sensitivity."

? "The parts of your skin that need to be most sensitive, like your fingertips and your lips, have more receptor cells in them than other, less sensitive areas. Your brain has a 'sensory map', with more space devoted to some areas of your body than others."

The cold tap water would be uniformly distributed, and triggering a more reactive response from all areas of your fingertips ?

 

Per your recommendation I thought I'd do  a natural void and then cath. The NV was 250cc but much to my surprise the PVR was 500cc for a total void of 750cc. I didn't feel any urge to void at all after the NV...

When I first started CIC there was always feeling of fullness after the NV and after cathing. Seems like that feeling is now gone....so I'm thinking maybe I should increase the number from  4 to 5 a day.

Hi Self-Help,

Do you have a source to your statements and conclusions other than the 1764 paper noted.  You could post a link or send me a private message. Thanks. 

Jim

Jim

Jw, Did you have a "strong urge to urinate" before the 750cc total void ? Or any urge at all ? Hank

Felt like I could go before the NV but there was no urge or sensation at all before self cathing I just thought I'd check out whether there was anything left per Jim's recommendation. I was very surprised with the 500cc....

You can still void 250cc, without any meds, which is encouraging. Hank

750cc is too much to be carrying around. It will keep your bladder in a stretched state which is the opposite of what you want to do. You should therefore adjust/increase your cath schedule so that the total void is 400ml or under. It may end up being 5x/day or 6 or even more. Just go by what your bladder is holding, not a number. The only way you will know this -- other than to get a portable bladder scanner -- is to always do a NV before CIC. Later, when you get a better idea of what you're carrying around, you don't have to be as rigid. If you do want to go the portable bladder scanner route, let me know. I have one and find it useful from time to time. 

Jim

Actually I'm on Finasteride haven't had any side effects to speak of and its shrunk my prostate to 45cc which I figure cant be a bad thing. Also its helped me to grow a heck of a white beard, my daughter thinks I'm Santa Clause lol...

Yeah still being able to void 250 is good...not knowing I'm retaining 500 not so much..

I've started 5x a day. I'm going to do a 24 hour log tomorrow with NV's as its been quite awhile since I've done one and that should give me a better idea of what is going on.

I was surprised by the urodynamics and the retention. There seems to have been a significant change in my neurological status in the last month, but actually that's kinda how it goes brain/nerve wise, I go along fine then have a drop in function then go along fine the drop again...similar to folks with vascular dementia, which is where I'll end up eventually..

Jim

I decided to keep a 24 hour log and cath about every four hours. I attempted a NV each time but there were a couple of times when there was nothing. The thing I noticed was that the NV are much less than they were in the past and except for two times the PVR's were less than 400.

10/1/17 12:22 AM    20    

10/1/17 12:22 AM    340    Catheter

10/1/17 2:50 AM    100    

10/1/17 3:54 AM    290    Catheter

10/1/17 9:03 AM    80    

10/3/17 9:03 AM    400    Catheter

10/1/17 1:00 PM    100    

10/1/17 1:00 PM    300    Catheter

10/1/17 5:15 PM    20    

10/1/17 5:15 PM    230    Catheter

10/1/17 7:07 PM    100    

10/1/17 8:45 PM    125    

10/1/17 9:32 PM    225    Catheter

10/1/19 11:53 PM    50    

Total 10/1/2017    2380    

Not really sure what to make of it except I suppose I should be doing CIC at least 4x a day maybe more? What do you think...

@jw: except for two times the PVR's were less than 400

------------------------

I think you meant to saw "total bladder volume", not "PVR". Total bladder volume would be the sum of your catherized void and the natural void just preceding it, assuming  you had a natural void.

So, the schedule you posted looks good. You cathed six times and except for only really one exception, where total bladder volume was 480, not too much over. 

I would not at all be concerned about lower natural voids at this point. It's simply because of the more aggressive cath schedule. It's just math. At this point you want to focus on decompressing your bladder which you by keeping total bladder volumes 400ml or below. 

I would stick to the schedule you just did -- 6x/day -- and keep up the log, at least from time to time. Should volumes change down the road, you can always adjust the cath schedule.

Jim

As to sometimes having no natural void before you cath, I wouldn't worry about that. It's normal.

Jim

 Just to add to the above, regarding no natural voids when you cath, do you feel an urge at that point or not? I'm assuming you don't feel an urge, and you just catherized per schedule. 

Again, perfectly normal not to have a natural void sometimes when on an aggressive 6x/day cath schedule. In fact, in the beginning, I almost never had natural voids when I was doing CIC 6x/day. 

Down the road, if you want, you can experiment and delay the cath if you don't get a natural void. Like wait an hour (or until you get an urge) and then try a natural void and a cath. If the total bladder volume on the delayed cath is under 400ml, then fine. If it goes over, then you know that the 4 hour schedule works better. 

A lot of this has to do with how much time you have on your hands and I wouldn't go crazy trying to tweak things at this time unless you have the time. The schedule you did seems to work pretty well.

Jim

Yeah I meant total void. I was trying to stay more or less on the schedule, didn't have the urge to void. I don't have time to screw around much with experimenting so I'll just stick to 6x a day.

BTW Have you had any experience with taking the catheters through airport security? I'm going to be out of town for a week at the end of the month and will have to fly 6 hours. I was going to put a couple of cartons of the coude in my checked baggage but was thinking of taking a few loose ones in my carry one but I dont want some screener to be waving them around and asking questions....

I haven't heard of any problems but I carry a doctor's note plus keep at least two days worth with my carry on in case the check in luggage doesn't get there. Where you could run into an issue is with the "liquid" requirements, if you're carrying alcohol or something like that, so in that case just read the regs.

Jim

I flew for the first time with my catheters in August.  Like Jim, I carried a couple days supply in my carry on, with the rest for the 12 day trip in my suitcase.  I also carried a copy of my prescription, just in case there were any questions.  I went through security both times without any questions.  I carry the individual lubricant foil packs, which are below the liquids limit and, therefore, shouldn't generate questions.  I also carry the Purrell Cottony Wipes for disinfecting.  I don't use them all the time, since they have alcohol in them, but I keep them in my travel kit for occasional use.

I keep a reusable cath in my travel bag (just in case, haven't come close to needing it since Rezum) and every 9 months or so, some aggressive TSA agent feels the need to open the case. pull it out, do show and tell and ask what it is. It can happen.

I also carried a reusable red rubber with my carry on as xtra insurance if my disposable Speedicaths somehow disappeared or got used up. I still have a box of them somewhere, I think. Probably not a bad idea to have them around for emergency situations. One red rubber could probably last you weeks. 

Jim

Jim

That's what my concern is and I don't want it to be an issue so I'm thinking I'll restrict fluids, self cath right before going through security and hope the checked bags get there with me. It's a flight I've taken many times before without losing anything but I have ran into a couple of jerk TSA guys.