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    Urodynamics Test

    Yesterday, my husband and I went to the doctors office to do a urodynamics test. It was the most embarrassing thing I have went through with my husband. I felt like I could have done this test on him if I had the directions on a piece of paper like the nurse did.

    When we left I felt so AAAGHHHHH! I just wanted to cry and it wasn't me being proded.

    It was my understanding that urodynamics eval would cover these items: Post Void Residual, Cystometrogram, Electromyogram, Leak point pressure and Uroflow.

    It seems to me that none of these could accurately be done since he couldn't void on his own and can't feel sensations below injury. What exactly was this test suppose to tell us?

    They kept saying he was having bladder spasms. Is that a good thing? Is that why he is leaking? His bladder use to hold way more than he is getting out now. The doc put him on ditropan xl 25 mg a day to help with his leaking. It worked great to begin and we can still roll him over in bed without soaking bed, but now he cannot go more than 4 hours without cathing or he gets soaked.


    Any help would be greatly appreciated!
    Tonya

    Husband, Ron, is a T-7 complete as of Oct. 06

    #2
    Yeah...the urodynamics testing was terrible for me It is what put me in a ridiculous state from my CSA. That and my stupid cysto...

    Those tests, besides being VERY invasive....are suppose to see how much residual is in the bladder...and if there is any control down there. I believe all those wonderful probes register spasms, and muscle control.

    That was nice that you at least were allowed to go in with him, though.
    My boyfriend (now husband) would have passed out! But I was totally freaked out I totally understand how you were...and like you said, you weren't even the one recieving all the daggone probes.

    http://kidney.niddk.nih.gov/kudiseas...amic/index.htm

    I'm not sure if the above link will help..or if you can even access it, because I've never added a link yet, so sorry if it doesn't work for you.

    Take care. I hope your husband has recovered...and you, as well.

    bbs

    Comment


      #3
      Ideally, urodynamics for a person with a SCI should be done using videourodynamics and a computer that coordinates the tests and collects and prints out the data. The tests should include a CMG (cystometrogram) and an external sphincter EMG. Uroflow is pretty much useless, as is a urethral pressure profile, for people with SCI. The videofluroscopy part of videourodynamics also shows what occurs with the intermal sphincter and shows any reflux of urine from the bladder up towards the kidneys (which is abnormal). If the person voids during the study (common) a PVR (post-void residual) can also be determined.

      It is certainly not the most fun test in the world, with a special catheter in place, a drape to collect any leaked urine, another catheter and balloon in the rectum, and either a surface or needle electrode in the perineum (to measure the external sphincter EMG). Done by the right technicians (GU techs, specially trained GU nurses or a urologist) it can provide invaluable information needed to custom design a bladder management program that is both effective and safe.

      Urodynamics is the ONLY test that can tell you what the intravesicular (inside the bladder) pressures are, what the true safe capacity is, and what happens to the internal and external sphincters when the bladder contracts. Of course the test results still have to be interpreted by a competent neurologic urologist.

      Not bladder spasms, but uninhibited bladder contractions (sometimes referred to as bladder spasms) are what is causing his leaking. If he is leaking and/or has high bladder pressures, and is put on medications to treat either or both, then the urodynamics should be repeated in another 3 months to be sure that the problem has been corrected, and should then be done every 1-2 years thereafter (more often if there are problems such as more leaking, AD, or frequent UTIs.). It is common for the bladder to become more spastic over the first year as spinal shock completely resolves (we never do urodynamics sooner than 3 months post injury) and it can continue to change neurologically over the person's life-span, which is why the tests are needed over and over.

      High bladder pressures can damage the bladder, and in the past, undiagnosed and untreated pressures were a major cause of renal failure in people with SCI.

      (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


        #4
        I had one done last July when I started loosing bladder control.
        My doctor suggested I get Monarch Sling surgery to help me gain some control for a little while longer but didn't know how long.
        It wasn't the most pleasent test.
        What was bad was, I was the first SCI pt thay had run one on so both doctors and half the staff was in the room and I was the guinea pig

        They ran the Urodynamics and an updated EMG to make sure it was my SCI that was causing the lack of control. The surgery helped some, at least I don't pee on myself anymore if I sneeze , LOL
        If the Army & the Navy ever look on heavens scenes, they will see the streets are guarded by United States Marines!

        sigpic
        www.jccarolinaformals.com
        www.myspace.com/jccarolina
        http://www.facebook.com/pages/JC-Car...10436735695158

        Comment


          #5
          I had one performed about 20 years ago and that was one too many! Maybe if I could have one done at a SCI center I might reconsider.... but never at a "regular" urologist's office. The plastic "throne chair" was hilarious... my butt was too skinny for it and I kept almost falling through it. That balloon was a trip too!

          Bob.
          "Be kind, for everyone you meet is fighting a great battle." - Philo of Alexandria

          Comment


            #6
            Thanks to everyone for your replies!

            KLD Your info is great and I will be printing it out to take to the doc when we go back for our appointment. I have a question for you though. Everyone keeps saying a neurological urologist. I have searched every method possible to find such a person but can't seem to. Do I have to call every one of the urologist and ask if they are one? Could there be an easier way?

            Thanks JC for your info! I too got the impression he was their first SCI patient. They were clueless. The meds my husband is on seems to be helping out for now. I feel better now knowing that leaking could be result of the fact he is still coming out of shock.

            Bob, I could agree with you but I know it something that he has to have done. I would just like it to be done right atleast by people who are professionals at it.

            Thanks again! I always need everyones comments for my own mental status and to try and do what is best for him.
            Tonya

            Husband, Ron, is a T-7 complete as of Oct. 06

            Comment


              #7
              No, there is no easy way to find this out. There is no separate board certification for this (although a few urologists have also taken the SCI Medicine board exam). There is a AUA special interest group for neurologic urology, so you can ask if they are a member of AUA and if they belong to this group. Mainly, you want to ask them if this is their specific specialty, and if it is, where they received their training in this area. A clinical rotation during residency or fellowship at a VA SCI Center, or Model System Center or other major SCI center would be a big indicator of having at least basic preparation in this area. Usually the front office staff will be able to tell you the urologist's subspecialties, which might include cancer, female incontinence, pediatrics, etc. I also suggest interview them to make a selection, either by phone or in person.

              I would also want to know if the nurse or GU tech doing the test (if not the physician) are certified in urology by the SUNA (formerly the AUAA).

              (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


                #8
                Urodynamics Test 1st time

                Can anyone give me some info on what they felt during a Urodynamics Test? My Doctor wants me to get one after have a large kideny stone removed from my bladder a few months back as my flow has not been that great on average (sometimes great like a race horse, other times just dribbles or I have to push to evacuate). Or I also go like 5-8 times a day too other times. Don't wake up at night anymore though as I used to, can hold it all night now which is nice.

                I have had scopes up there before and they tried to do a large catheter to get a clot out after the surgery, that did not go over well at all, they never got more than a 1/2 inch in and I was screaming! The scope to remove the stent, I needed to get heavily relaxed on a couple Valium in order for them to pull the stent out, guess I'm just too sensitive down there?!

                Doctor told me the cath is only spaghetti thin, so it is smaller then other things I've had and the other contraption (Camera??) for the rectum was smaller too for the invasive part.

                What does the procedure feel like to anyone that has had this done? That is my biggest concern at the moment....

                Thanks
                UROMAN

                Comment


                  #9
                  Uroman

                  did you have your urodynamics test done yet? if not, let me know...
                  Although, I'm female, so... it may be different.... but my experience wasn't good, so maybe you don't want to know it


                  bbs

                  Comment


                    #10
                    Just to put another spin on this- the information that KLD posted regarding the importance of this test is still true. While they are not too much fun - if you can find someone who is experienced in providing it to someone with a sci, it isn't the worst test in the world. The key is finding someone who you are comfortable with in doing it.

                    Please don't postpone this test if you are having any problems with your bladder. As KLD says, it is the only test that we have that provides us with the information that is needed to develop a solid bladder program.

                    Happy New Year!

                    CKF
                    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


                      #11
                      Hmmmm...I have had Urodynamics tests run 3 times since my injury 71/2 years ago. It sounds like your doctors are using turn of the century equipment! I actually enjoyed my tests (quit looking at me like that!) because you can visually see the points on the monitor where the bladder begins to spasm and can associate the sensations with those points. By using relaxation techniques (sort of like bio-feedback) you can stop or ease the spasms, thereby learning to assert some control over your bladder muscles.

                      I am L-1, cauda equina, and intermittant cath is my only method of voiding. I normally use a #12 fr. cath and the catheter they used to completely drain bladder at start of test was only a 14fr. The electrode was only a 16 or 18fr and with the lidocaine infusion wasn't that much of a stretch! (excuse the pun) I even have strictures in 2 places in my urethra that forced me to a 12 from a 14fr a couple years ago. The rectal electrode is nothing if you're used to digital stim regularly.

                      I'd say get a new Urologist and make sure the new one uses the videourodynamics test. Judging from several of the reactions posted here, the difference between it and what you all have been getting compares with the difference between modern surgery and Civil War era "amputation"!!!

                      Kap
                      accept no substitutes

                      Comment


                        #12
                        urodynamic testing

                        I'm so sorry to hear about the experience your husband suffered during a urodynmic test. That's not the way it is suppose to be. ( reading the directions while doing the study, that's so wrong on so many levels).

                        I run an onsite/mobile urodynamic testing company here in southeastern NC and I staff only qualified RN's to do the study, who have completed several hours of continuing education and are dedicated to patient care and comfort.(b/c it can be embarrasing)

                        Now let me help explain why the MD ordered the study. The urodynamic test is a test that determines if a patient has a functional or a structural problem. Typically functional problems only require medication or perhaps surgery if there is any form of prolapse. Structural problems are surgical interventions and if that be the case, how much surgery do they need.(mostly in females)

                        The study is watching for how fast one urinates, is their stream broken, do they have trouble getting it started, volume etc. Very important in male testing.

                        The cytometry portion of the study is watching the outside of the bladder, the detrusor muscle and is prematurely contracing, which is called overactivity. With the inside of the bladder we're looking for bladder compliance, capacity and sensation. And then, once they reach urgency with volume we have them void/pee. Again, very important in men because this is going to tell us are they obstructed or stenosed.

                        Now during all this, a well trained nurse would know what she was watching for when there were other issues that needed addressing, especially with patient history, such as spinal cord injuries or stroke patients. There are multiple symptoms along with patient history that can determine patient outcomes, diagnosis and treatment, that a qualified RN is able to determine. (not by reading the directions as you go) (I'm sorry that really bothers me. I pride myself on my patient care and my skill level)

                        I know this is pretty basic infomation. But I hope it helps. Probably, what your doc was looking for was, does your husband have an open bladder neck or is he having overactivity w/his detrusor muscle. Which the urodynamic test would be able to diagnosis.

                        Again, I'm sorry you had such a bad experience. With my patients I have them laughing. I explain everything and I don't sneak up on them. And before they know it, they are finished and out the door with a definite diagnosis.

                        Please let me know if this helps. I will be happy to answer any further questions.

                        I've been trying to work the Jacksonville area for the last 2 years, but I can't get any doc's to return my phone calls or letters. Which is too bad b/c it sounds like your doc's office could use a trained RN.

                        My best to you and your husband. Kim, RN-C

                        Comment


                          #13
                          For SCI pts, you need also need a Video and fluorosopy called VCUG
                          (x-ray) with a recording of the bladder and when you void or leak and an EMG of the sphincter, which is by patches around the rectum. Also a catheter in the rectum to meassure abdominal pressure. These are the things that cxan diagnose DSD and other problems. This is done by, or with a specially trained NP or MD to this and interpret the study.

                          CWO
                          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


                            #14
                            I had one of these tests done a couple of months ago but still have a another month to wait to get in to see the doctor about the results. Other than finding it very embarrasing, the nurse I had was great and put me very much at ease. I am a bit confused though - I have injury L4/L5/S1 ?below and from what I have gathered if this was causing bladder control issues it would be a flaccid? bladder that would overfill. During the test I had a residual volume after trying to void of about 100mL, but then when they filled my bladder (which I couldn't feel at all, nor the catheter) she said it started to 'spasm' at about 280mL. Is this consistent with lumbar/sacral nerve damage and is this likely to cause long term problems left untreated?

                            Comment


                              #15
                              i had this done as part of the process of getting my eureter fixed and heck, just from being an SCI. sucky............really sucky...........when you are a man {or heck, anyone} and they stick you in the stirrups it's gonna suck. if it's any condolence getting the calcium encrusted stint pulled out of my penis with a long grabber without any kind of local was actually more traumatic, but just by a little.............sorry you have to go through that, steve.
                              Steve Garro. www.coconinocycles.blogspot.com

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