Supra Pubic Catheter?

My husband has been a C 5-6 quadraplegic since 1972 and has been relatively healthy.  
In 1998 he had a sphincteratomy due to high urine residuals and had to have it again in 2000.  Both of these procedures were successful and his voiding returned to normal.  
In Nov. 2002 , he again had high residuals....only when sitting in his wheelchair.  He would void 200-300 and retain 800 to 1200 cc. so I was catherizing him .  He had his 3rd sphincteratomy on Jan. 6, 2004 and now is not voiding at all when in his wheelchair and when catherized he is retaining 900 to 1200.  While in bed he drains fine.  
His urologist wants to run tests on him while he is sitting to see if he can figure out his problem and is talking supra pubic catheter.  
Do you have any suggestions or recommendations?
Thank you
Bill and Linda

[Kevin Pho, MD]

Urodynamic studies may be indicated.  Urodynamic testing is helpful when the diagnosis of lower urinary tract dysfunction is unclear, when objective findings do not correlate with subjective symptoms, when a patient fails to improve with treatment, and when surgical treatment is planned.

The main components of urodynamic testing are cystometry (measuring bladder pressure during filling of the bladder), uroflowmetry (measuring urine flow over time), pressure-flow study (determining whether poor flow is due to obstruction or detrusor weakness), and urethral pressure profile or leak point pressure (for diagnosis of intrinsic sphincter deficiency).

A suprapubic catheter is basically an indwelling catheter that is placed directly into the bladder through the abdomen. The catheter is inserted above the pubic bone. This catheter must be placed by a urologist during an outpatient surgery or office procedure. The insertion site (opening on the abdomen) and the tube must be cleansed daily with soap and water and covered with a dry gauze.  If there is increased urinary retention that is not improved with surgery, a suprapubic catheter is a reasonable option.  

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:
Flesh.  Urodynamics.  UptoDate, 2004.

[augi114]

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