Over Distended Neurogenic Bladder Question

[KenJr.]

There is every evidence that my over distended neurogenic bladder (possibly caused by spinal stenosis) will never return to its normal size.  I don’t have even the slightest urge to urinate until there is at least 750 ml of urine in my bladder.  Even then only 10 to 20% of my bladder empties naturally.  The remainder gets self catheterized.  Note:  I'm 67 years old.

I currently self catheterize 5 times daily, and typically 2 of those 5 times includes some non-catheterized urination.  The total amount relieved ranges from 300 to 1250 ml with an average of 640 ml.

From what I’ve read, too much urine in the bladder on a frequent basis can cause urinary tract infections and kidney problems (I had frequent urinary tract infections before diagnosis).  In a normal bladder, from what I’ve read, one shouldn’t exceed 500 ml.  Mine is apparently permanently stretched and does not seem to build up any pressure to speak of until there is considerably more than 500 ml.

When the amount I catheterize is the 300 ml range, the urine is typically somewhat dark (indicating that I should take in more water).  When the amount relieved is in the range of 640 ml, the urine color appears normal.  Only when the amount relieved is very high (>1000 ml) does the urine seem light in color (maybe taking in too much water).   I really don’t know when there is too much or too little urine in the bladder.  When I’m at rest, the urine seems to build up much faster than when I’m active.  Yet, I don’t want to have to set up 2 alarms for waking to urinate during the night (I currently set it to wake me mid way through my night’s sleep).   Last night I urinated 1000 ml total at 4:00 am even though I had last relieved myself at 12:15 am.  Yet, at my next relief (at 9:00 am), I only urinated (self catheterized) 480 ml.  In other words, if I’m to self catheterize even more frequently, what should I set my new schedule for?  When should I drink more?  When should I drink less?

Time for the question:  If one’s bladder is stretched considerably beyond normal, is it still necessary to maintain no more than 500 ml of urine within?  I can see where a normal bladder would exert significant pressure, possibly forcing urine back toward the kidneys if more than 500 ml is built up.  But, it would seem that with this oversized bladder, that pressure would not be present at 500 ml, but at a higher volume level.  

I would like to NOT increase my frequency of catheterization to beyond 5 times a day.  But I must admit, I typically see more than 500 ml of urine on each of my urination experiences so I worry about maybe causing urine tract infections, kidney problems, or eliminating the remote possibility of the bladder returning to normal.

Note:  I track and graph all my pees on an Excel spreadsheet, with emphasis on the natural pee to catheterized pee ratios (graphed when both occur), looking for any sign of improvement in bladder tone.  So far, no improvement.

[Kevin Pho, MD]

It may be possible that in the chronically distended bladder, it may be able to hold more than 500mL.  The amount of urine it takes before kidney damage occurs would be patient dependent.  It is true that the neurogenicity of the bladder would increase the risk of UTIs.

One consideration would be a permanent catheter (i.e. a suprapubic catheter) - which would remove the need for self-catheterization.

Checking the kidney function via blood tests can also be considered.

These options 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.

Kevin, M.D.
kevinmd_

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