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  • bladder surgery?

    Hi everyone. I had a T4 complete in March. Due to some pretty intense leg spasms ( I broke 2 abductor mirrors), I have not been successful in self catheterizing and have an indwelling catheter. My rehabilitation doctor suggested that if I still have the indwelling after a year, I should consider continent diversion surgery. Any thoughts from anyone?

  • #2
    Are you quite obese? Why have you been unable to self cath? While it is not easy at T4, many women do it. Are you taking spasticity medications? Have you considered adductor Botox injections? We have used this quite successfully for a problem like this. We also teach a "touch, no mirror" technique for female self caths. Where did you do your rehab?

    If you are at a year post injury and cannot cath, or find it too difficult, then I would strongly recommend you consider a Mitrofanoff instead of a urinary diversion which would (I assume) mean an incontinent urostomy which would mean wearing an appliance glued to you all the time and draining into a bag. I would not see a reason for you to have a continent diversion such as a Indiana or Kock pouch, which is a big surgery, and really only appropriate for those who must have their bladder removed and then want to continue with some form of intermittent cath. A Mitrofanoff is much less surgery, and potentially reversable if you should change your might down the road, unlike a continent or incontinent diversion. A Mitrofanoff involves using your appendix (or rarely, a small piece of small intestine) to make a catheterizable conduit from your bladder to your belly button. You then cath through your belly button every 4-6 hours.

    Do a search on our forums to find a lot of information about the Mitrofanoff procedure. Not all urologists do them, so it is critical to see a urologist who has done a lot of them. This is often a pediatric urologist as they are done more for children with spina bifida than any other group.

    Please complete your profile. It makes it much easier for us to answer your questions if we know a little more about you, and makes you more credible to your peers here.

    (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
      Thanks for answering so quickly. I'm a little overweight but not obese. I take zanaflex and when my doctor tried to increase the dose, my blood pressure crashed. I really would not like to inject botox into my legs because I started a lower body exercise program to try to regain some function. I've tried cathing by touch, but sometimes I can't get my legs apart or I spasm and lose balance on the toilet. My rehabilitation was done at Helen Hayes Hospital in New York State.

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      • #4
        Were you taught to cath in bed and in your wheelchair first? Most find doing a transfer just to cath too much of a burden, and of course you have to deal with often not-too-sanitary public toilets. Done correctly, adductor Botox might also help with ambulation if you are incomplete, since a scissors type gait is very difficult to manage safely and is very inefficient.

        Regardless, I would urge you to get information about a Mitrofanoff vs. a continent diversion. If your urologist is not familiar with the Mitrofanoff, find someone who is.

        (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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        • #5
          Thank you so much for your advice. It is greatly appreciated.

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