10 month old male voiding problems

[khkbrown]

My 10 month old son is having problems voiding his bladder. He has been cathiter free for the last three months but for the last month we have been batteling UTIs and the bladder is still holding about 100 mils of urine. What are our options to prevent UITs and help rid the bladder of urnie in the hopes that it begin contracting normally?

[Stephen Liroff, MD]

Your son has had a catheter? Why? What tests have been done and why can he not empty his bladder? I need a lot more information to understand his problem. Please provide this.
S.A.Liroff, M.D.

[khkbrown]

Thank you for your response. My son was born with an imperforated anus. The lesion was very high and during the anal reconstruciton surgery the bladder nect was injured. The bladder was also overfilled during several cystograms to determin the grade of urninary reflux he had. He had a regular cathier and then a super pubic cathiter to allow the bladder to heal and then again after two dilations of his urethra that became blocked. It's now been 2 months since the cathiters and the bladder is still not emptying.
Thank you for your help

[Stephen Liroff, MD]

Your son's inability to empty his bladder has several possible causes. The first that comes to mind involves the nerves that enable a person to urinate successfully. These may not be functioning because of a spinal cord problem. These are associated with imperforate anus set of problems. Also, if he has high grade reflux, the volume left in his bladder following voiding may really be urine that had refluxed up to his kidneys that has come back down to his bladder. The surgical reconstruction may have resulted in the formation of a urethral stricture (narrowing of his urethra  because of scarring) or damage to the nerves as they join the bladder/prostate.
I trust that your son is being cared for by a pediatric urologist and that this physician has obtained an MRI of your son's spine (or an ultrasound at an earlier age) looking for problems in this area. I would think that a postoperative voiding cystourethrogram (not a nuclear cystogram) has been performed to evaluate his reflux at this time as well as look for urethral obstructions. A pelvic ultrasound may be helpful. I also assume that he is taking an antibiotic  daily to try to prevent urinary tract infetions.
If all of this does not help, you might discuss a cutaneous vesicostomy (bladder opening onto the abdominal wall) to enable bladder emptying in the short term while his bladder matures.
Good luck! It sounds as though you are dealing with a lot here.
S.A.Liroff,M.D.

This information is provided for general medical educational purposes only. It
does not  necessarily reflect the opinions of Henry Ford  Hospital  or the
Vattikuti Urologic Institute.  Please consult your physician for diagnostic
and treatment options pertaining to your specific medical  condition

[Stephen Liroff, MD]

I forgot to mention that your son's bladder function can be assessed  objectively with a cystometrogram. This test will give you an idea of how his bladder is functioning, and can help in the future to see if change is occurring.
S.A.Liroff, M.D.

This information is provided for general medical educational purposes only. It
does not  necessarily reflect the opinions of Henry Ford  Hospital  or the
Vattikuti Urologic Institute.  Please consult your physician for diagnostic
and treatment options pertaining to your specific medical  condition