UroDynamic Study Tomorrow, so what to expect?

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ozziebee

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So I'm off to the urologist tomorrow for a UroDynamic Study done. Am feeling nervous, a bit anxious, and not sure what to expect, or what the outcome will be.

I have to drink 1L of water an hour beforehand too. Have had little success in keeping all that water in before tests lately.

Any advice before I go?
 
The test is easy enough, and not dependent on you showing up with a full bladder. That's probably for them to run a post void scan before the the test. This is where you pee in a cup that is on a scale. This lets them see how fast of a normal flow you have, as well as any stops/starts in it. They then run an ultrasound over your abdomen to see what's left in your bladder. (Up to 30ml is considered normal).

The urodynamics test itself will be embarrassing and uncomfortable at best- but it is necessary. You lay back on a special recliner chair with no pants/underwear on and a bucket is put in front of you. They insert a special catheter in you and slowly fill you back up with water.

You tell them when you feel it, and when you feel like you can't hold it anymore because it's bursting full. (And they will push you on this) They note the volume in your bladder at various points, as well as internal pressure. You then get to pee out the catheter and total volume if you can. My advice, pee it out no matter what or the test is invalidated and will need to be repeated at a later time.

Their system is carefully calibrated and lets them know exactly what your bladder is doing in response to the filling and voiding. It also tells them your bladder capacity (400-600ml is typical), and how well you are emptying your bladder.

From there they will better know whats going on, as well as how to treat any problems.
 
IIRC, they stick 2 small probes up the butt to help assess bladder electrical stimulation issues.
 
LittleICme said:
IIRC, they stick 2 small probes up the butt to help assess bladder electrical stimulation issues.

*Sometimes. Sometimes a small electrode needle stuck in between your legs, and sometimes none of those. This is all dependent on the type, sotification, and age of the diagnostic machine they are using. Newer machines typically don't use that though.
 
Well, result is in, and it couldn't be started. They simply could not insert the catheter into my urethra. So now, it's another cystoscopy to review possibility of the stricture having worsened from when my urologist saw it at my cystoscopy in November.

Before they attempted insertion of the catheter, I weed 540ml over about 3 minutes of trying, and the difference between my last flow test, and this one were quite stark. This one was almost a flat line. So it looks like my bladder is not squeezing, even with large amounts in there, which should gush out under the pressure. But no.

My urologist has referred me to a reconstructive urological surgeon, for possible buccal mucosal urethral reconstructruction, but beforehand I'll need that new cystoscopy from the new surgeon.

It sounds like InterStim might actually be a possibility for me to fix this weak bladder.
 
DO NOT RELY ON INTERSTIM.

I've had the interstim test implant, and it absolutely fried my sacral nerve- making things much worse for me. Also look at their own inflated "success" numbers. They say half will see an 80% improvement. Well 50% of 80% is actually an overall 40% success rate. Not good. Not tocmention the whole point of interstim is to override and calm nerves, not make them work more.

Also, it's possible your bladder has given up on contracting an became weak because of your obstruction. Get thst fixed first, then start worrying about your bladder.

And my obstruction was 100% blocked. I simply could not even pee at all. Had to have a suprapubic put in through my abdomen for a couple of months. I'm really surprised your urologist didn't try to dilate you back open with sounding rods. It's temporary, but does work to open up a stricture for 2-3 months. Long enough to get you set up for a surgery or something.

I hope your cysto is really soon, and I would highlt recommend you ask to see if they plan to dilate you after it. Be warned though, getting dilated is a briefly painful procedure.
 
Slomo said:
DO NOT RELY ON INTERSTIM.

I'm trying not to, but it seems that, no matter how much volume I have in there, it doesn't want to squeeze. I thought before yesterday that with the bladder being full, it'd have pressure with which to use to produce a good stream, but no. It released ok, but just dribbled and dribbled and dribbled for three freekin minutes to pass over 500ml.

I've had the interstim test implant, and it absolutely fried my sacral nerve- making things much worse for me. Also look at their own inflated "success" numbers. They say half will see an 80% improvement. Well 50% of 80% is actually an overall 40% success rate. Not good. Not tocmention the whole point of interstim is to override and calm nerves, not make them work more.

Did you have it turned up too much? The literature I was sent yesterday suggested two stages of the Interstim.

Stage 1: they insert the electrodes, and install an external control device/programmer. You're taught how to use it, turn it on/off, and adjust the amplitude.
Stage 2: After 8 weeks or so, and it being successful, they implant the battery into the small of your back, and you use a remote programmer device to control the Interstim.

Also, it's possible your bladder has given up on contracting an became weak because of your obstruction. Get thst fixed first, then start worrying about your bladder.

Yes, this is what we're going to do.

And my obstruction was 100% blocked. I simply could not even pee at all. Had to have a suprapubic put in through my abdomen for a couple of months. I'm really surprised your urologist didn't try to dilate you back open with sounding rods. It's temporary, but does work to open up a stricture for 2-3 months. Long enough to get you set up for a surgery or something.

My Urologist did dilate my urethra back in November. Got it up to 22FR. She thought that putting me under now (was proposing tomorrow, actually) to do a cystoscopy + dilate + work out the bends in my weird urethra for catheter insertion next time I'm needing a Urodynamic test done, might actually be a waste considering the reconstructive urology surgeon she's referred me to will initially do exactly the same thing.

I hope your cysto is really soon, and I would highlt recommend you ask to see if they plan to dilate you after it. Be warned though, getting dilated is a briefly painful procedure.

She was suggesting that if she did it, she could refer me to her continence nurse to show me how I can continue to do daily dilations. I told her that, based on my reactions in the failed UroD study a few minutes prior, the chances of my successfully sticking something up there myself is zip.

Thus our discussion turned to the BMR.

I sent my Urologist an email today stating that I'm booked in for a consult with the reconstructive surgeon in 2.5 months, and if that was too long a time. Her response was it's ok so long as I continue to pass urine ok. If not, to get in touch ASAP. We'll see what happens in the meantime, eh!
 
Mine was the test implant only, and I had it turned way down. On the 1-10 volt dial I couldnt even stand it at 1. It felt like an electric version of chineese water torture. The really minor shock was only mildly annoying at first (think 9 volt battery on the tongue, but only 1 volt instead) but it just kept piling up till it couldn't take it any more.

The interstim rep did have me messing with the settings a whole lot to try and dial in the right wave form, amplitude, etc., and even had me turn it down to 0.02 volts (the lowest it would go before shutting off). After three weeks of that I called it quits and just turned it off. Had them remove the darn thing the following week. That's when I realized my prior control problems were even worse.

I personally would recommend you follow through with another dilation too. Just the one to help get you through till your surgery in 2.5 months. If what you're going through is anywhere the same as mine, you will not make it till then without that, and will be in the hospital hoping to be catheterized instead. Likely even an emergency suprapubic through the abdomen. And thats much, much worse overall.

The Bucco Muscle (inside of the cheek) graph is probably a good bet, but inquire on just shortening your urethra by removing the bad section. This would straighten it out some while also saving you from the sore mouth. That might not be an option, but still worth checking on.
 
Am I the only one who’s urodynamic test involved 3 separate incredibly painful catheterizations? First they checked residual (only about 80ml, I was retaining about 300ml normally at the time), then filling (went to 1300ml), then draining the residual after I let out as much as I could (around 800ml was still in there).

They had probes attached via sticker right behind my scrotum, and my urologist (who was not the one doing the test- that was done by another uro, a tech, and a med student watching) told me “everything seemed normal” when he reviewed the results, although I didn’t really think retaining 800mL sounded so normal to me, lol.
 
Insertion of their special catheter device is about the same as any other catheter. Filling of the bladder is only as painful as normal urine filling the bladder.

Me personally I have a urethra sensitivity and urge incontinence. As you can imagine, insertion and filling my bladder were bith painful. Add in my dyssynergia where I had to push and strain to pee even without being blocked and yeah, that test was excruciating. And to think I had it done to me more than a dozen times.
 
PlotTwist said:
Am I the only one who’s urodynamic test involved 3 separate incredibly painful catheterizations? First they checked residual (only about 80ml, I was retaining about 300ml normally at the time), then filling (went to 1300ml), then draining the residual after I let out as much as I could (around 800ml was still in there).

They had probes attached via sticker right behind my scrotum, and my urologist (who was not the one doing the test- that was done by another uro, a tech, and a med student watching) told me “everything seemed normal” when he reviewed the results, although I didn’t really think retaining 800mL sounded so normal to me, lol.

Yours sounds pretty much the same as mine, except I didn't have any pain. They filled me up to 1200ml and all I could feel was a slight discomfort in my abdomen and when they took the catheter out, I involuntarily let loose about half of it, all over the chair. My bladder just doesn't receive or react to any signals of being full, it just lets go whenever the pressure is too high, and only just enough to release the pressure. The residual volume in there was the reason I was getting near-constant UTI and kidney infections.

That was when they reccomended i start using intermittent catheters, and that has been a huge improvement for me. I still leak sometimes, if my bladder is filling up faster than usual, but one or two diapers a day is a heck of a lot cheaper than five. And I haven't had an infection in about 5 years now.
 
Well, I go and see the reconstructive surgeon next week.

In the meantime, my urges have increased in frequency, power, and pain. Stress IC has returned. I'm finding it really hard to begin urination, and often need to stand up for gravity assistance.

Last night I had about 3 hours of almost non-stop painful urges and wets into my night nappy, which kept waking me up. This morning, it was soaked (possibly my heaviest yet, and that was with a soaker pad too). This evening when I was changing I noticed I'd actually wet the bed too last night, and never realised it.

Today I've had urges on and off, with pain. I went into a 4pm meeting, which lasted over two hours, sat through urges and little wets, and a flood after I got off the train, which caused a leak and wet pants for the first time. That nappy was soaked when I took it off this evening too.

I just want to wet without all the pain. So what do I ask the doc to do?
 
That sounds quite a lot like Slomo's experiences I've ready of, and partially mine (although I wouldn't consider myself having pain, more just 'discomfort'). Unfortunately, Slomo is banned until Monday (IF he decides to come back), so he won't be responding any time soon. In his stead, I can say that he went through a series of many sphincterotomies in order to allow the urine to flow freer. You can look back to previous posts for more info, but I remember him saying there was a lot of push back from doctors who didn't agree with effectively making him permanently and totally incontinent in exchange for pain relief.
 
I'm back. Though why I was banned in the first place I have no idea.

Ozziebee I replied to your PM. Personally, I don't believe a sphincterotomy works all that great. Maybe a radical sphincterotomy though, or a reconstruction. Stomas (ileal or continent) are definitely not the way to go either. And interstim has a horrible success rate of just 40% so I don't recommend it.

Either way you'll need to figure out exactly what is causing your problems first. In the mean time, inquire about a -temporary- suprapubic catheter to give you a little relief untill the underlying problem can be fixed. You can let it drain into your diaper no problem. Just make sure you stay well hydrated to keep it constantly flushed out.
 
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