Urodynamics-need answers please-Quix?

[rendean]

I had urodynamic testing done today. What a confusing mess. The Uro-gyn stated he was positive I did not have an "MS bladder" since these types of bladders are neurogenic and allow unlimited filling of the bladder until leakage occurs. He told me  and showed me via his computer screen that the EMG reading was extremely high and my bladder was hypertonic. He said he didn't know why the pressures were so high but would research it. Anyway, couldn't finish the testing because after refilling my bladder I could not empty my bladder, at all. He had to cath me to empty my bladder.  The initial voiding showed 175 cc residual urine post void. Since I won't get results for a few weeks, anyone have any ideas? Brief goggling did mention hypertonicity in MS but we don't know about the sphincter control due to inability to complete the testing. Help anyone? Quix?

[rendean]

Agreed!! Bad bladder!  Funny you should mention the voiding diary because this uro today was basing all his assumptions and testing on the diary.

[Quixotic1]

I have to share something my urogynecologist said about MS and the bladder.

She said that in someone with MS, she doesn't pay too much attention to the voiding diary, because, "The MS bladder is a terrible historian."  The symptoms don't always correlate with the actual dysfunction seen on the urodynamic testing.

Bad Bladder!  Bad, Bladder!

[Quixotic1]

yup!

[rendean]

Well, if you mispoke so did the urologist. His narrow definition of a MS bladder is your description of a floppy bladder. My understanding of your description is, it can be floppy or spastic, either way is not functioning properly due to nerve damage. Correct?

Again, thanks! I appreciate your help!

Rendean

[Quixotic1]

I misspoke above, though I think you understood me.

"Broadly, a neurogenic bladder is a very general term for a bladder that doen't function properly 'due to damage to any of the nerves that control the urination process.'"

I left out that last phrase.

[rendean]

Yes, it does help. Thank you. This is the specific uro-gyn that my acadamic neruo sent me to so I expected better answers. I also thought,and read, that the bladder can be spastic and cramp just as my legs do. My only complaint was bladder spasms that resembeld UTIs but otherwise were not bothersome. (no UTIs BTW) The neuro wanted to know about the bladder function as he is trying to hone down my dx to MS and/or Sjogren's. I left so frustrated and confused, not to mention sore. And according to the uro, no real answers since we couldn't complete the testing.  He said he would study all the data including the voiding diary I kept for them, etc. It's not that I want MS, I just want an answer and with all things pointing in one direction I don't need some numbskull relaying incorrect information.

I will discuss this in detail with my neuro at my April appt. Tomorrow is the SSEP. More fun.

Thank you so much for your explanations! I knew I wasn't totally crazy (well maybe a touch..:-).

Again, thanks. Now I can go to sleep without tossing this around in my head.

Rendean

[Quixotic1]

Hmmmm....What the urologist told you is NOT what I understand about what MS can do to the bladder.  While it is true that "Neurogenic Bladder" often refers to the floppy bladder that can't contract to expell urine - it doen't have to be that.  Your neurologist is using a very narrow definition and doesn't seem to understand the variety of ways that MS can affect the bladder and urination.

Broadly, a neurogenic bladder is a very general term for a bladder that doen't function properly.  MS can affect the bladder muscle and the sphincter in several ways.  One of the ways is the way described above, but it can also cause the bladder to be spastic or dysfunctional with spasms.  In this there would be high pressures in the bladder.

Then the sphincter can be too loose, or it, too can be spastic and have too high a tone.

Or ther can be a breakdown of the coordination the (synergy) between the bladder so that the sphincter doesn't relax at the right time to allow the urine to be expelled when the bladder contracts.  Or the sphincter does relax, but the bladder relaxes at the same time.  This is called Detrusor (name for the bladder muscle) Sphincter Dyssynergia.

ALL of these can happen in MS.

So, I definitely disagree that the high pressures you have can't be from MS.  Of course they can.  My urogynecologist works with my MS Neuro.  She has been quite clear that any disfunction can be seen with MS.

When I had my Urodynamic testing last month they found that I have a pretty normal behaving bladder, but a spastic sphincter.  She called my problem DSD.

No matter what they call it in the end, the same things are tried to treat it, so the distinction doesn't matter so much unless you are looking for help with diagnosis.

Does this help?

Quix