Unable to initiate urination

[lordoffords]

I am 59 years old and have multiple spinal disorders. The worst is at L3-4. I had severe stenosis at this location, the neurologist told us after surgery that the cord was only one half MM thick. I have difficulty walking and large areas that are numb on the skin. Mostly a saddle area in my crotch and in both legs with complete numbness on the bottoms of my feet. I have no reflexes at my knees, when he uses a tool to run up the bottoms of my feet there is no reaction. It is getting worse as he was not allowed (insurance) to put any type of instrumentation on my spine or even a fusion. Just a discectomy Eventually it will collapse on the one below. He told me I would never get any better because the nerves were dead. I do not have any muscle control to squeeze the urine out of my bladder so I sit on the toilet and try to let it drain out. Recently it has become much worse, while I have some numbness in my penis I have great pain in my testicular area and probably prostate as well. It takes a great deal of stimulation for arousal but I cannot achieve erection or orgasm. He showed me how to self catherize myself but when it gets to the prostate it is very painful. Once past that I feel nothing. The DR. did all the work-up and determined I have a nuerogenic bladder. The scope showed inflamation in the tubes from my kidneys. I am in a losing situation. Is there any procedure, medicine, or anything that can be done. The next step is it starts damaging my kidneys. Although the self Cath sounds simple it is a giant problem with me. As my family life span is usually in the nineties I cannot see anyway I can endure this that long. I am considering the permanent solution, I can handle that. I want to know what, if any, other options I have.Thanks, Ivan

[Kevin Pho, MD]

If a neurogenic bladder is an issue with a long-term timeframe for recovery, you may want to consider a more permanent catheter - which would prevent the need to self catheterize.  One option would be a suprapubic catheter.

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.

These catheters usually are changed by qualified medical personnel. The catheter may be attached to the standard drainage bags described above. A suprapubic catheter may be recommended in people who require long term catheterization, after some gynecological surgeries, and in people with urethral injury or obstruction.

Complications of suprapubic catheter use may include: urinary tract and/or kidney infections, blood infections (septicemia), urine leakage around the catheter, skin breakdown, bladder stones, and blood in the urine (hematuria). After many years of catheter use, bladder cancer may also develop.

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.

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[kevinmd]

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