Need clarification on Neurogenic Bladder

[Diane__0__0]

    
      Re: Re: Re: Need clarification on Neurogenic Bladder
    


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Posted by CCF Neurology W6 MD on October 22, 1998 at 02:56:13:

In Reply to: Re: Re: Need clarification on Neurogenic Bladder posted by Diane on October 21, 1998 at 01:20:04:
  
  :
  : Doctor,
  Thanks for your quick and thorough response to my questions.  I really appreciate the work that you all do, it is very helpful for us, especially those of us without insurance.
  After reading and understanding (I think)your explanation of my flaccid bladder, I am wondering if there are any tests that can be done to determine if the cause is indeed due to a nerve problem or not.
  The reason Im asking is that my problems have been going on for about 5 months, and as hard as I try to self cath correctly, I still get UTI's and occassionally kidney infections.  I have had some of the basic tests for MS (I have many other problems/symptoms), and am scheduled for Mayo Clinic in two weeks. Because I am on Elavil to prevent migraines and also because I need an anti-depressant, I understand that the Neurologist, Urologist, and medical doctor all need to agree that going off Elavil is best for my situation.  
  So, if their recommendation is going off Elavil, the only problem I have is that after discontinuing that med, they will want to wait 6 weeks to see if there is a change or improvement. Instead of feeling like nothing is being accomplished while we are waiting, I'd like to have a test performed to see if my problem is nerve related or not.  
  I hope this makes sense, and sorry for rambling.  Thanks again for your help!  Diane
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Dear Diane,
Thank you for the follow up question. I gather from your previous posting that you have not had a test to delineate this bladder problem.
I think that it is very important to undergo this test (called urodynamic evaluation, your urologist should know about this) for several reasons:
1. History of urinary retention with large volume of urine left over after voiding
2. Frequent UTI's
3. Kidney infection
4. Evaluation of symptoms (it is unfortunately impossible to accurately predict what the urodynamic will show based on the clinical findings alone)
5. Monitoring of voiding pressures
6. Evaluation and monitoring of treatment
I am glad that you will be undergoing an evaluation at the Mayo Clinic
and wish you all the best.
There are other medications for migraine you can take that won't cause
urinary retention, so yes, I still think that the Elavil is not a good choice here.
Good luck.