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Urology (Expert Forum)
Unexplained Urological Retention
Answered by
Kevin Pho, MD - Internal Medicine
Kevin Pho, MD
Boston - MA
Questions in the Urology forum are answered by Dr. Stephen Liroff, affiliated with the Henry Ford Hospital. Topics covered include benign prostate disease, penis curvature, cystisis, kidney stones, pediatric urology, prostate, sexual dysfunction, urinary tract infections (UTI), and urological cancers.
Unexplained Urological Retention
by Peds, Apr 12, 2004 12:00AM
I am a 25 year old woman with an array of medical problems. I have been diagnosed with conditions such as spina biffida occulta, depression, migraine, irregular periods and chronic urological retention. My medication includes citalopram, codiene phos., lanzoprasole, paracetamol, diclofenac and migraleve. The problems that are most affecting me is my constant back pain, my concerns over the fact that I only have up to four periods per year but am still constantly hormonal; and my biggest concern, chronic urinary retention (Since Sept. 2003). Finally, upon examining my medical history it was noted by urology that I had been suffering from stress incontinance for years but was too embarrassed to see my GP about it. I had lived with it for so long that it became relatively normal to me. In addition to what I have told you, I feel that it is important to note that I have not had any children as yet because, I realise that pregnancy and childbirth can sometimes affect continance.
I have been in hospital under the care of both urologists at and neurologists. Tests such as 'bladder pressure tests', undertaken by Urology confirmed that the problem rests with my bladder muscle which no longer contracts, even when I have something like 600mls in there! I only realise that I need to go when I am feeling discomfort (pain) and of course I know by the clock. Neurology taught me to do ISC Intermittant Self Cathedorisation which I perform every 3-4 hours before allowing me to go home.
I was then referred to Neurology where I had tests such as nerve conduction studies (was getting numbness and pins and needles down my legs) and lumbar punctures. I believe all was OK and I was discharged. Neurology was quite traumatic for me and I still do not know what might be causing the bladder muscle abnormality -I am still completely lost and I REALLY feel all alone with this problem. Neurologically, i'm fine.
Do you know of anything that I can ask my GP about as a way of getting closer to identifying the cause of my retention. I am worried that my Drs are going to give up on me because they are trying everything that they can but are not coming up with much. Might there be anything else that I can ask them to look for that might bring some answers? My Urologist thought that my retention was down to my back problem and nobody has disputed this - could this really be a cause and could my not reporting my stress incontinance, have worsened the situation?
I am or course happy and grateful that there is a solution to my problem but after six months I was hoping to see some improvement.My future without ISC is looking bleak. I am really not settling well with having to do ISC every 3-4 hours. I really don't want to do this forever. It is causing problems for me. Is there a longer term solution for this problem -a wonder drug, surgery, permenant cath. - I need to know! I am conscious that I am prone to UTI's each time I ISC. Any advice is good.
Sarah
I have been in hospital under the care of both urologists at and neurologists. Tests such as 'bladder pressure tests', undertaken by Urology confirmed that the problem rests with my bladder muscle which no longer contracts, even when I have something like 600mls in there! I only realise that I need to go when I am feeling discomfort (pain) and of course I know by the clock. Neurology taught me to do ISC Intermittant Self Cathedorisation which I perform every 3-4 hours before allowing me to go home.
I was then referred to Neurology where I had tests such as nerve conduction studies (was getting numbness and pins and needles down my legs) and lumbar punctures. I believe all was OK and I was discharged. Neurology was quite traumatic for me and I still do not know what might be causing the bladder muscle abnormality -I am still completely lost and I REALLY feel all alone with this problem. Neurologically, i'm fine.
Do you know of anything that I can ask my GP about as a way of getting closer to identifying the cause of my retention. I am worried that my Drs are going to give up on me because they are trying everything that they can but are not coming up with much. Might there be anything else that I can ask them to look for that might bring some answers? My Urologist thought that my retention was down to my back problem and nobody has disputed this - could this really be a cause and could my not reporting my stress incontinance, have worsened the situation?
I am or course happy and grateful that there is a solution to my problem but after six months I was hoping to see some improvement.My future without ISC is looking bleak. I am really not settling well with having to do ISC every 3-4 hours. I really don't want to do this forever. It is causing problems for me. Is there a longer term solution for this problem -a wonder drug, surgery, permenant cath. - I need to know! I am conscious that I am prone to UTI's each time I ISC. Any advice is good.
Sarah
Doctor's Answer
by Kevin Pho, MD, Apr 12, 2004 12:00AM
, Apr 12, 2004 12:00AM
Nerve problems in the back may be a possible cause to the incontinence issues. You may want to consider further testing for evaluation. I am going to assume that obvious causes, like an infection has been evaluated for via a urinalysis.
Here are some urodynamic tests that you can consider with your urologist.
* Fluid cystometry demonstrates bladder proprioception, capacity, detrusor stability, contractility, and voiding efficacy.
* Simultaneous measurement of abdominal pressure is necessary to exclude the effects of abdominal straining.
* Fluoroscopy, abdominal leak-point pressure, or profilometry is required to detect and quantify stress urinary incontinence.
* Pressure-flow studies are required to evaluate outlet obstruction.
If ISC ceases to be an option, and there continues to be no clear cause, you may want to inquire whether a suprapubic tube may be considered. A suprapubic catheter is basically an indwelling catheter that is placed directly into the bladder through the abdomen. This option can be discussed with your urologist.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Thanks,
Kevin, M.D.
Bibliography:
DuBeau. Clinical presentation and diagnosis of urinary incontinence. UptoDate, 2004.
Here are some urodynamic tests that you can consider with your urologist.
* Fluid cystometry demonstrates bladder proprioception, capacity, detrusor stability, contractility, and voiding efficacy.
* Simultaneous measurement of abdominal pressure is necessary to exclude the effects of abdominal straining.
* Fluoroscopy, abdominal leak-point pressure, or profilometry is required to detect and quantify stress urinary incontinence.
* Pressure-flow studies are required to evaluate outlet obstruction.
If ISC ceases to be an option, and there continues to be no clear cause, you may want to inquire whether a suprapubic tube may be considered. A suprapubic catheter is basically an indwelling catheter that is placed directly into the bladder through the abdomen. This option can be discussed with your urologist.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Thanks,
Kevin, M.D.
Bibliography:
DuBeau. Clinical presentation and diagnosis of urinary incontinence. UptoDate, 2004.
Member Comments
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