post hysterectomy left ovary removal and bladder problems

[kayaeli]

I had a total abdo hyst with left ovary removal (cyst)in Aug 2006. Voiding problems ever since.
In hospital could not pee intially, did not perform an in/out but they decided I was dehydrated and gave me a bolus. Started peeing every 30 min to one hour. Bolus stopped. Discharged home peeing continues every 30 min to one hour 24/7 normal bladder volume pale urine. UTI - negative. Went back to surgeon-treated as an overactive bladder and nerve damage. Given ditropan XL. A cystogram and cystoscope both negative. Voiding pattern changed to very little concentrated urination for a few days alternating with lots of pale urine 24/7. Ditropan XL increased-no avail- same pattern. Ditropan XL discontinued. Renal scan/ultrasound negative. Voiding pattern changed to several weeks of decreased concentrated urine alternating with a couple days of increased pale urine. Now is March-voiding pattern is several times in a row in the morning, concentrated urine to paler urine (e.g. 3:00am, 4:00am, 5:00am, 6:00am etc for 5 or so times in a row), then stops, nothing urge during the day for 6-8 hours and when I do go, it is concentrated and about 250 ml. Rarely is it pale anymore.
My surgeon and GP have no idea what is going on. My urine tests/ cultures are negative, although show a consistantly elevated urine osmolality. Urodymanic test ordered. Nephrologist ruled out any kidney problem. Endocrine now looking but no answers yet.  Scheduled to have right ovary removed soon because of pressure/pulling and maybe the cause? Any ideas of what is going on with voiding pattern?

[Lennox Hoyte, M.D.]

Nocturia is defined as waking up from sleep to void more than twice per night. This is not normal. Often a cause can't be found, but it can sometimes be due to fluid shifts when lying down, or it can sometimes be related to sleep apnea, or cardiac problems. It sounds like you are waking up multiple times at night to void. Another source could be  large fluid intake before going to bed at night.  If all of the above can be ruled out successfully, then there is a medication which can slow urine output at night, but patients who take it have to be rigorously monitored with regular blood tests to keep their electrolytes in balance. The medication is called DDAVP, and should only be prescribed by an MD who is knowledgeable and willing to follow up with your required lab testing.

[kayaeli]

thank you for your reply - since posting my voiding pattern shifted a bit - 5:30am  (400 ml) , 6:00 (300ml), 7:30 (350 ml) , 8:30 am (250 ml) often going from conc. to pale. - then sometimes I have no urge to go for several hours ( 6-8 hrs). Most time, when I am not going during the day - I have pressure around my abdo/bladder area. Is somewhat relieved when I void - but is usually only 250ml.

I do not drink large amount of fluid before bedtime  - in fact my eating/drinking pattern, in general, has not changed pre/post surgery.

Endo problems since ruled out, Urogyne thinks not a bladder issue.