Prostate Trial Voids - What Are Steps Your URO DOC Uses?
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My Uro Doc wants me to "cut my Direct Foley Catheter" early in the morning of our afternoon, ~ 1PM, appointment. Then, drink as much fluid as possible for the next 3-4 hours and until I VOID, if possible. Then, visit his office at the appointment time so he can measure "my retention"....The problem is I might have an Uncontrollable Void while I'm on my way to his office.....If "my retention" is "too much" and/or I don't Void, then the URO Doc puts me back on the Foley Direct Catheter and schedules me for another Trial Void in 4 weeks..I had a REZUM on August 15th.....While I was in the hospital for Lung Surgery on June 15th my FLOW Stopped..The hospital and another URO DOC used some type of equipment to "force water" into my bladder and then, I was to attempt a TRIAL VOID, but I was unsuccessful ~ 8 times....The first URO Doc wanted to do a TURP so I switched to the current URO DOC who has successfully performed hundred's of REZUM's and TUNA's.....My Question is Why Doesn't the 2nd URO DOC use equipment to force water into me too?.....Is His TRIAL VOID procedure as I described above considered normal procedure for TRIAL VOIDS by Most or a Lot of URO DOCs?.....Please Comment...
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jimjames randy_85492
Posted
My guess is that thousands of unecessary operations are performed each year based on a mis-diagnosis from so-called void tests. Biggest culprit is the ultrasound test as described earlier by JohnClen. Next would be the urodynamic test, and finally the bladder scan test performed in the doctor's office.
The common element in the way these tests are performed is that the patient is asked to agressively fill their bladder by drinking large amounts of fluid in a very short period of time.
While a bladder in excellent shape may be able handle this type of forced fluid load, bladder's in less than ideal shape often cannot. So in the latter case, what happens is that the result of the void test is artifically high compared to the real-world retention which is the amount of fluid in your bladder as you go about your normal day. And, in my opinion, the only figure you ever want to base a surgical decision on is your real-world retention and not any retention figure after artifically forced fluid intake. Just because your bladder cannot handle artificial fluid loading well does not mean you need an operation. Just probably means you should watch your fluid intake somewhat!
If you want to know what your real-world retention is, unfortunately you have to do it on your terms and not your doctors, unless you are lucky enough to find a urologist of like mind but don't count on it. If you happen to be self cathing, it's very easy as explained by JohnClen. If you happen to have a portable bladder scanner at home (very pricey) it's also easy.
So, putting those two options aside, that only really leaves getting a portable bladder scan in your doctor's office the right way, which could involve a little patience plus some cooperation from your doctor.
The overall concept is to have your doctor scan your bladder after you urinate while you are on your normal daily fluid intake schedule. In other words absolutely no fluid loading to rush the test along.
You can probably figure out the logistics of this yourself, but "yes" it could involve waiting a little longer at the doctor's the usual. Trying to time your doctor's appointment during the times of the day you usually urinate could save time. And you might want to repeat this at least once or twice by making appointments at different times of the day. A talk with the doctor or nurse prior might be helpful as well. Just explain that you don't do well with forced fluid intake and you would prefer to have them measure your post void residual based on your normal fluid intake. Be prepared to get a funny look but remain steadfast.
Jim
Waffalobill jimjames
Posted
MY doc scans mine after normal fluid intake and void at office when I visit. Helps to keep a log as well of intake and output. Then you can see what's going on and tell him as well. If your taking in more than your voiding or voiding multiple times go get rid of intake, something's up. I to thought that urodynamics was stupid. Wasnt real happy about them pumping me full of fluid . How can your void be natural when your being filled up unnaturally? It has to freak your bladder out a bit to be filled that full, that fast. The whole test and environment is not normal. How can normal results be expected.
jimjames Waffalobill
Posted
It's great that your doc doesn't rush your scan by asking you to drink xtra fluids, or maybe you are able to go pretty much any time which a lot of us can't. Either case, it sounds like you're getting a real world PVR which is the only one in my book that really counts when trying to decide if an operation or procedure is necessary.
So when they did my urodynamic test, the fellow kept adding and adding water to find the threshold where I feel the need to urinate, so I said, "what are you at" and he said "900ml", and I said, STOP
It was crazy because at home I feel the need to urinate at around 400cc so the artificial filling was giving useless data.
As far as home urine logs are concerned, I'm a big fan but you have to be careful how you interpret the data. Fluid in does not always equal fluid out for two reasons. First, we lose a certain amount with perspiration. But probably more significant is that the fluid you take in today may not come out until tomorrow. It's first in and last out plus as we get older, we may retain fluid in areas other than the bladder.
For example, in my case when I have a lot of sodium/salt in my diet, I might take in a lot of fluid but not much might come out that day. But if I cut back on the sodium the next day then the flood gates open!
That said, logs still can be useful if you don't get hung up on day to day swings and they certainly are helpful in terms of measuring natural void amounts. And if you self cath, like I do, then you can also get an exact PVR figure at home.
Jim