I suffer from significant urethral spasm. Had urethral dilation under local anaesthetic about a year ago and felt that my symptoms worsened afterwards. Spasm has become progressively worse and is almost unbearable from mid cycle up to menustration. Urologist is now suggesting random medications for detrusol over activity. I have sought 2nd opinion and he - like me agrees that treatment for overactive detrusol is unlikely to help as I do not have any of the symptoms that would normally be associated with detrusol over activity. Capacity, frequencey and emptying of bladder all normal. Urodynamics study essentially normal aside from some evidence of detrusol spasm that could be related to a reaction to the procedure itself - given the absence of symptoms normally. 2nd opinion - is suggesting that there may be some merit in undergoing dilation under general anaesthetic and cauterizing nerves if inflammation is observed. I have been reading as much as I can on the treatment of spasms. I am a bit weary of cauterizing as an option (due to my lack of knowledge). My question really is whether urethral dilation could possibly be more successful under general anaesthetic. I was thinking of going for this option again and then going on a strong course of anti inflammatory directly afterwards. I get some mild relief from nurofen plus. Any ideas? Many thanks.
I question the diagnosis of urethral spasm altogether. One can have bladder overactivity which is manifest by an urgent need to void, urinary frequency, incontinence of urine. There are also pelvic pain syndromes that are not well understood, but are not true urethral spasm. There may be pelvic pain which may be associated with change in voiding pattern, pain with sexual activity or just exist by itself. Also, there is endometriosis with its cyclical pain related to the hormonal changes that occur during the menstrual cycle.
I think that you should see a female urologist (a urologist who is specially trained in the subspecialty of female urology) for a hands on third opinion. Most teaching institutions with urology departments have at least one faculty member with such training. Bring your old records to the appointment.
You might consider posting your question in the Interstial Cystitis Forum.
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