Is it realistic not to be colonized at all?

[xsfxsf]

I’ve been intermittent cathing for 11 years. I’ve gone years without UTIs but lately not so much. Usually I’m colonized. In the past there hasn’t been too much difference in lifestyle between colonization and no infection.

The trouble now is that I have also developed significant incontinence. For that it makes a big difference: if colonized the odor associated with incontinence is a nuisance. Is there some way just to not to have any colonization over the long term? Maybe with gentamicin instillation?

[SCI-Nurse]

You can certainly discuss gentamicin instillation with your urologist, although it is not a guarantee to provide a sterile urine. Doctors and scientists have been searching for years to find a remedy for colonization in people with neurogenic bladders; not only in those doing intermittent cath but in those who reflex void and those who use an indwelling catheter. Doing sterile vs. clean catheterization makes no difference, so technique of self cath is not the issue.

When did you last have urodynamics studies done? Generally they should be done every 2 years for anyone on intermittent cath or who reflex voids, but if new problems appear they should be repeated. Have you also been screened for urinary tract stones? Any new meds?

Until you can see your urologist, you may need to wear an external condom catheter (ECC) between your caths to keep your skin dry and any odor down.

(KLD)

[August West]

I have ultrasounds done every 1-2 years. That includes measuring how much residual urine is left after straight cath. Do urodynamics studies consist of more than this? Maybe they test how much back pressure is against the kidneys?

[SCI-Nurse]

Urodynamics for someone with a SCI/D should consist of a combined CMG (cystometrogram) where they measure the pressure inside the bladder with a special small catheter attached to a transducer, and an external sphincter EMG, which can be done with either surface electrodes or needle electrodes at the anus (since the external urinary sphincter and the anal sphincter are both part of the same pubococcygeal muscle). The combination shows the pressures that occur in the bladder as it fills, and if the bladder contracts, does the sphincter relax or get tighter. Since your bladder's behavior can change with time, it is recommended that this be done every 2 years, and more often if there are problems such as new incontinence, an increase in UTIs, more AD caused by the bladder, etc. (KLD)

[August West]

Spoke to my urologist about urodynamics. He said it was done several years ago but the results rarely change over time. Is there a study that shows that it needs to be done periodically?

[SCI-Nurse]

Urodynamics measures the pressures during filling and emptying. Overtime the bladder can develop high pressure when filling and when testing. This can be due to the bladder becoming stiff. Other things bladder can change. How much do you hold) capacity)? This may be smaller, have more spasm at a higher pressure and/or lower capacity. Are you on anticholinergic s or mirgabetron? CWO

[SCI-Nurse]

It is the Standard of Care by SCI doctors and SCI urologists. If not done routinely, definitely done with frequent infections and any changes, similiar to what you mentioned. Especially if there is a change. You can read the PVA Guideline on Bladder Management which is online. Or any other SCI literature and studies. Dr. Timothy Boone is the neuro Urologist who trained me (called voiding dysfunction Specialist) over 40 years ago the leading cause of death in SCI persons was due to kidney failure from high pressures and backing up of urine in to the bladder causing kidney failure requiring dialysis if not death. Urodynamics and management of the high pressures changed that is not an issue. Think of it like your blood pressure-have to check it and treat high blood pressure -even though may not have symptoms and prevent other issues like heart failure and stroke. Renal ultrasound would show this after kidneys sitting in urine or backing up into the ureters/kidneys. UDS would show pressures before this occurred. Cystoscope can also be done looking for thick bladder walls, and trabeculations which are common but also look for lesions and if they see will do biopsy but this is not as common as changes/increases in pressure and decreased bladder capacity. You have to know capacity-how much you hold (how much you get from cathing is helpful) and what is left in with voiding/bladder contraction (residual). But doesn’t show the whole picture. Neuro urologists have special training in care of SCI persons and others with neurological and nerve dysfunction. What else does he propose to do!? CWO

[August West]

Thanks for the information. This is very useful!

[RollingInParadise]

im always sterile never colonized. i do the gent instills

[CapnGimp]

Bob that lived in Florida and posted on here often, years ago, who died, was T4 and used peroxide to clean/store his IC caths in for many years was not colonized all those years. When my stones are removed, using Microcyn flushes twice a week, I remain uncolonized until the stones return over a year later.