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Instruction sheet in hand, I ran up to the Receptionist’s window begging for a restroom urgently, but very urgently! The very first instruction stated quite plainly, “Arrive at the clinic with a comfortably full bladder.”. but I miscalculated. What happened next is the subject of my post contained in, “PAE DISAPPOINTMENT JOURNAL”. Please turn there and read from the first paragraph to the end of the document before continuing here.
The above distraction meant that my typed guidelines would remain in my briefcase, unread. Thus, if the lubricating gel was laced with Lidocaine or equivalent, then that is what I was going to get down my urethra. And presumably the same would apply to the pressure-sensing balloon to be placed in my rectum.
I changed into a gown, and was prepped for urinary and rectal catheterization. The rectal catheter went in first and I didn’t feel a thing. The urinary catheter was duly set out in the catheter tray where the first two inches from the tip were given a liberal coating of gel. I accepted the invitation to insert the catheter myself but this was too challenging so I deferred to the nurse operator. She was really good. My confidence level went up several points, but again I felt nothing. That ubiquitous Lidocaine, I bet. Well, the deed was done but, as things turned out, entirely for the better.
Nurse operator got her urine sample for testing then drained my bladder, I believe. Then came the main test where the bladder is filled very slowly through the catheter. For the purist, I should point out that the saline solution was pumped in by the latest, most up-to-date equipment, at constant pressure and constant flow rate.
Throughout this fill process I was continuously asked if I felt anything. By “anything” she meant an urge to void, but I felt absolutely nothing. Then, some 6.5 minutes into the test I began to feel a very slight sensation at 327 ml. First desire to void occurred at 347 ml, and a strong urge occurred at 363 ml. A further 187.4 ml was added to bring the system up to 707.0 ml maximum fill. I did not feel pain at this high level so assumed that the solution had begun to flow out around the outside of the catheter and the test was concluded.
Next came the pressure testing. At detrusor peak flow (10 ml/sec) pressure was at 33 cm (13ins. water column). I was then able to induce a contraction that raised this to 72 cm (13 ins. water column). What I find far more significant is that this fits perfectly within the range I was given by the urologist who trained me over 70 years ago! Conclusion: my detrusor is in great shape for an 87 year old.
Finally, the report “No Blood Loss” and “No Complications” speaks volumes as to the skill of my nurse operator. By way of closure I wrote a letter of thanks to the doctor in charge and amended my position regarding use of analgesics: applicable for self –catheterization, but definitely not so for urodynamic testing clinics.
Impression: Consider TURP vs CIC. We both agreed that CIC was the best alternative.
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