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Bladder neck closure - still leaking

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    Bladder neck closure - still leaking

    Hi SCI,


    Im a Spina bifida MMC from India. Been recently operated(2 months ago) for Augmentation cystoplasty with mitrofanoff procedure and bladder neck closure.
    I was operated on 4th october, and on 20th october my penis leaked urine(I had a spasm or some sorta pain)
    Any idea why would it be so? also the color of the discharge from my penis does not match the urine, the discharge is more of fluorescent/green and not yellow like the urine.
    But during cystogram the constrast material did leak out of the penis in force, which means a pathway exists b/w d bladder and urethra, so what's the fluorescent color discharge?
    Is it an infection?
    Last edited by ValanM; 8 Dec 2018, 11:37 AM.

    #2
    Have you had the discharge analysed and cultured? How much discharge are we talking about? Why did you have a bladder neck closure? Previous sphincterotomy?

    Unfortunately, there is a pretty high rate of urethral fistula development after bladder neck closure. You need to further investigate this with your surgeon.

    (KLD)
    The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

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      #3
      It was analyzed before it turning to green when it was yellow, it was in the month of October.

      The discharge would be around 8 ml per day, and flows out during pressure.

      My sphincter muscle doesn't work/contract, hence it was closed as it could lead to leakage

      If it's a fistula how is it treated? and do they reoccur?
      Last edited by ValanM; 10 Dec 2018, 3:08 AM.

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        #4
        Fistula like this can be very difficult to treat; surgery in that area is not easy. What does your surgeon say?

        (KLD)
        The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

        Comment


          #5
          My surgeon says, there are chances for it to heal naturally, its already 7 weeks, not sure if it has to heal how long would it be. If it doesn't heal then further investigations would have to be done, perhaps a surgery.

          Any idea why will color of the discharge not always be as that of the urine? its often green/fluorescent?

          Comment


            #6
            If you have a fistula, what you are seeing as discharge may be a combination of pus and urine. Again, did you have the discharge cultured recently?

            (KLD)
            The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

            Comment


              #7
              Oh okay, also with that being told, I would like to add that im getting quite a few pus boils in the surrounding area, on my thighs, one after the other. No, I have not done a culture lately, perhaps i will do one soon.

              The problem with getting the culture is the little amount of discharge, and having it collected in a sterile container.

              My surgeon did mention my urine will have pus for some time post surgery. By any means is this life threatening?

              Comment


                #8
                You should be able to "milk" the discharge from your penis, if not, ask your physician to provide you a "culturette" which is a cotton swab and a tube partially filled with culture media (ask him/her how to use it), and carefully insert just the cotton part of the swab into your urethra, then place (without touching anything) into the culturette.

                Your boils should also be cultured so that they can be properly treated with antibiotics.

                Any infection has the potential to become blood borne, which can lead to sepsis, which can be life threatening.

                (KLD)
                The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

                Comment


                  #9
                  Sure, will do so, also i have been on antibiotics before.. levoflox, whilst on antibiotics the discharge color changed to yellow/transparent(along with mucus). However post the antibiotic course, the discharge color changed back to fluoroscent

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                    #10
                    Also why is treating this fistula considered difficult?

                    Comment


                      #11
                      Originally posted by ValanM View Post
                      Also why is treating this fistula considered difficult?
                      Because, as above, getting to it surgically is difficult due to the other organs, nerves, and blood vessels in that area. Also, urine being such an irritatant to soft tissue, it is nearly impossible for the fistula to close back up itself, even if urine is diverted (such as with a temporary SP catheter).

                      (KLD)
                      The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

                      Comment


                        #12
                        Originally posted by SCI-Nurse View Post
                        Because, as above, getting to it surgically is difficult due to the other organs, nerves, and blood vessels in that area. Also, urine being such an irritatant to soft tissue, it is nearly impossible for the fistula to close back up itself, even if urine is diverted (such as with a temporary SP catheter).

                        (KLD)
                        Looks like I'm in a hopeless situation. As this needs to be fixed..Does the surgery have many risks, can it mess up things .. and if u have to compare the fistula surgery with augmentation cystoplasty, as the latter itself is a big surgery. I might be asking too many queries ..Its getting me depressed.

                        Comment


                          #13
                          Originally posted by ValanM View Post
                          Looks like I'm in a hopeless situation. As this needs to be fixed..Does the surgery have many risks, can it mess up things .. and if u have to compare the fistula surgery with augmentation cystoplasty, as the latter itself is a big surgery. I might be asking too many queries ..Its getting me depressed.
                          Get back with your surgeon. This is not something we can resolve through our forums.

                          (KLD)
                          The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

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                            #14
                            Sure thanks SCI

                            Comment


                              #15
                              Btw.. just an FYI, it self healed.. around April - May 2019

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