Bladder Outflow Obstruction

Dear Kevin
I had bladder problems all last year (frequency and pressure). Ultrasound of bladder was normal, pelvic scan showed a number of prominent fibroids. I saw a urogynaecologist who did urodynamic testing and diagnosed outflow obstruction due to retroversion of uterus plus weight of fibroids. He wanted to perform a ventrosuspension but lead surgeon (not himself) recommended against it due to potential adhesion formation. Had laparascopic myomectomy in December 05, including cystoscopy and hydrodistension / dilatation.  They use special mesh on the uterus to prevent adhesion formation and  I had very little discomfort so far from that area.  During surgery nothing notable found in bladder ie IC or endometriosis. Bladder was very sore for 4 weeks post surgery despite antibiotics. I feel that I still have 'outflow obstruction' - urine stream is thin and reluctant and I have to push to void properly.  Sometimes bladder is sore, mostly just when I need to go and possibly a bit after.  Sometimes have burning feeling inside or at tip of urethra but not all the time. Have had a number of urinalysis tests which are all clear.  

I have known about retroverted uterus all my life but never known it to cause symptoms like this. I am 40, never been pregnant. I would like to know if you feel it's possible that the retroversion could really be causing the ongoing bladder problems or if something else could be involved? For instance adhesions, urethral irritation from cystoscopy, something entirely else?  Also would like to know what you think of the ventrosuspension operation - seems somewhat controversial.  Although somewhat late we are still hoping to have a baby in next few years and I am starting to wonder what consequence all of this could have if I do fall pregnant!  

I have had constipation and spasms of both large and small intestine, including pain under belly button, from about 4 weeks post op, have been taking Buscopan but still ongoing.

Thank you and regards
Suey

[Kevin Pho, MD]

I am not a urologist - thus I cannot give an informed opinion on the ventrosuspension operation.

If all the anatomical issues (i.e. adhesions etc.) have been ruled out (i.e. via a cystscopy and CT scans), you can consider infection as well as interstitial cystitis.  I would assume that the urine has been tested for a variety of infections - including STDs.  

I would consider testing for IC.  This can be done via a potassium sensitivity test that is arranged by your urologist.  

Another urological opinion can also be considered - preferably at a major academic medical center.

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.

Kevin, M.D.
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[Jackie B]

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