Aa
Aa
A
A
A
Close
333672 tn?1273792789

Urodynamic testing results

This was the most unpleasant and painful test I've had so far. The tech made me sit in this chair that looked like something out of a medieval torture chamber and all sorts of electrodes and sensors were attached to me. I was supposed to empty my bladder into this funnel, but I found it very hard to do, especially as I was unable to relax while perching forward precariously on this chair.

I knew I was emptying incompletely, but on this occasion I apparently still had 750 ml of urine in my bladder after my best attempt. The urologist did not think this was a good thing, especially since the normal total capacity of the bladder is only supposed to be around 500 ml.

After emptying my bladder, the tech started filling me up with sterile saline water and I was supposed to say when I got the urge to go.  The she drained me again

RESULTS:

*Sensory neurogenic bladder: This seems to be the cause of most of my problems. My bladder does not get the signal that it's full until way late ("delayed first urge" was what the urologist called it). When the tech was filling my bladder with water, I never got a real urge to pee and didn't even have the first bladder pressure sensation until over 230 ml (and the sensations I did get were associated with bladder spasms). Apparently, the normal first urge to pee is around 125-250 ml. Since this is supposed to be an automatic, autonomic process, the urologist didn't think I could consciously trick my bladder into thinking it is time to pee.

*Detrusor (muscle of the bladder wall) overactivity: I think this means bladder spasms. When the tech was filling my bladder, most of the bladder sensations I did feel were associated with bladder spasms (apparently abbreviated UDC for "undesired detrusor contractions")

*Large capacity bladder: Because I don't get the signal to pee when I should, my bladder capacity has expanded. My bladder muscle has some thickening of fibers.  This is not a good thing according to the urologist, who also said that an overstretched bladder can't squeeze.

*Detrusor (bladder) external sphincter dyssynergia (DESD): The sphincter muscle is apparently what enables you to be potty trained. Contracting this muscle prevents you from peeing when you don't want to.

DESD "is caused by neurological lesions between the brainstem (pontine micturition [urination] centre) and the sacral spinal cord (sacral micturition centre)."
http://www.ncbi.nlm.nih.gov/pubmed/2226060

"When detrusor external sphincter dyssynergia (DESD) occurs, there is a lack of coordination between the bladder and the external sphincter muscle, which is the muscle that controls the emptying of the bladder. Instead, when the detrusor muscle of the bladder contracts, the external sphincter may spasm and stay closed, rather than relax and allow urination."
http://www.americanmedicalsystems.com/conditions_signs_detail_objectname_mens_desd.html

In my case DESD is both a good and a bad thing. Good because it is preventing me from having accidents; bad because it prevents me from peeing when I want to.

*No SUI (stress urinary incontinence): I didn't leak when the tech asked me to cough or bear down so that's one positive thing. I only seem to leak when I've waited too long to go to the bathroom and then only a little.

*Normal EMG: I guess this means no problems with the relevant peripheral nerves

*Incomplete void (urinary retention)

The tech expressed surprise that I don't suffer from UTI's, but I don't. I think I maybe had one once in college.

I had my follow-up with the urologist last week.

Ideally, she would have liked me to to self-cath at least once a day before bed. Otherwise my bladder never knows what it feels like to be empty. Plus I likely could sleep through the night if I did this. However, my lack of fine motor control due to reduced sensation and proprioception in my hands means that I am unlikely to be able to self-cath. I can't do much of anything with my hands if I can't see what I'm doing. I have recently been making more effort to empty completely after all this depressing news, but I'm not sure how much good it's doing.

Before deciding what to do, the urologist had me pee in one of those plastic hats and then did a bladder ultrasound. With a lot of effort (more than I normally make) I managed to get out 200 ml and that left only 231 ml in my bladder. The urologist said she could live with this since I'm not having UTI's or discomfort. We will try conservative treatment for the moment with a six-month follow-up.

However, long term something will probably have to be done. Either I have to figure out how to cath or I will need some sort of more invasive procedure such as a  suprapubic tube (SPT) or what she called urinary diversion. Then she told me that she didn't want to escalate to that yet and that she always tried to think more than one step ahead. As time goes on, many MS patients develop cognitive difficulties and this can lead to bad bladder outcomes. She told me about a patient who had one of these permanent catheters who was in a long-term care facility. The patient had cognitive difficulties so didn't remember to empty her bladder and apparently the staff were also sometimes inattentive so the patient's bladder ended up rupturing three times. It was rather sobering that she thought this was a likely future for me (of course, my last neuro notes concluded that I "represent a high degree of complexity with significant risk of morbidity." That plus the fact that I am having more problems recently, especially with my legs, is forcing me to consider bleaker outcomes than I'd like.)

Anyway, this is probably TMI, but I hope some of this info about different types of urinary problems is helpful to someone.

sho
9 Responses
Sort by: Helpful Oldest Newest
294425 tn?1288528395
Hi Sho,

Thank you so much for taking the time to share the details of that experience - you always explain things so clearly and give extra background information which is so helpful.

I have been putting off this testing - now at least I will have a better idea of what to expect.  

Talk to ya soon,
Rita  
Helpful - 0
333672 tn?1273792789
Thanks, guys! Writing things out often helps me to organize my thoughts. I'm glad you found it helpful, too.

For those who haven't seen them, here are Quix's health pages, where she talks about other kinds of bladder problems.

http://www.medhelp.org/health_pages/Multiple-Sclerosis/The-Neurology-of-Bladder-Incontinence/show/758?cid=36

http://www.medhelp.org/health_pages/Multiple-Sclerosis/Urinary-Incontinence-Physical-Therapy---Part-I/show/759?cid=36

http://www.medhelp.org/health_pages/Multiple-Sclerosis/Urinary-Incontinence-PT---Part-Deux/show/760?cid=36

http://www.medhelp.org/health_pages/Multiple-Sclerosis/Urinary-Incontinence-PT--Part-Tres/show/761?cid=36

@Mary Yes, I think I did get a winner of a urologist. She's knowledgeable and takes time to explain things. The only drawback is she's too popular. I was originally scheduled to have this test in January and when they had to cancel, the next available slot was in April.

@Ren That would be too awful to go through all that for nothing. The urologist told me that there was more than one thing that could be causing my symptoms and this test would show which it was. So at least now we know more than before.

@Guitar_grrrl Yeah, you should make an appt. Honestly, I only went because of the forum and people talking about having UTI's and stuff like that without even knowing. Since I'm not having accidents or UTI's, bladder problems are annoying, but they aren't all that high on my list of complaints.

I had to ask the neuro for a referral. I feel better for having done it. It's better to know than not know and I guess the worst case would have been to have kidney damage before anyone knew I had a problem. Now at least I can feel comfortable that the situation is being monitored and problems will be caught early.

sho
Helpful - 0
2015036 tn?1332997788

Thank you so much for that very informative post.  I also appreciate that you broke it up, so that it was easier for people like me (cognitive issues)- as well as bladder issues, to understand.  

I hope that your urologist comes up with a better solution for you.
Tammy



Helpful - 0
738075 tn?1330575844
Wow, Sho!  That was an awesome post!!  Thank you so much for this.  I agree with Mary and JJ - this should be included in the health pages.

I really should start looking for a urogyn in my area - not that I want to share the throne experience, but to see just what's going on.  I have occasional incontinence, and I'm sure it's due to overfilling.  I'm often up twice/night, and sometimes I'm amazed at what I've held!

Again, thanks!  (((Shoshin)))


Helpful - 0
739070 tn?1338603402
Dear Sho,

You have so accurately described "the throne" and the testing. Certainly something I could have done without since my uro-gyn wasn't as forthcoming with the results because my case confused him.

He had never seen such a bladder with the muscle strength recorded on the EMG. Then there was the fact that due to some freak of nature, I still have a micturation center (nerves that tell me I have to urinate) present at the base of my spine. Infants have this reflex but as an infant grows , the micturation center moves to areas of the brain.

I luckily do not retain enough urine at this point in time to do ISC. What was even weirder about this doc is my residual was 50cc and all he offered me was an Interstim to make me urinate. Sorry, but I can accomplish that on my own.

The reason I went to him was two-fold;first as a sort of elimination exam before my diagnosis and secondly, I had had some instances of incontinence and some UTI that cleared very easily.

I'm sorry to hear of your results and the implications they may present but you have ALWAYS struck me as one of the most levelheaded, well-researched and knowledgeable individual on the board, I am positive that you will make the the very best of any situation thrown your way.

Warmly,
Ren
Helpful - 0
987762 tn?1331027953
COMMUNITY LEADER
Another wow Sho, that was a brilliant read, I am sorry its happening to you though!

I had wondered what happens with the MSers who have proprioception and tremor issues and now I know, it really was educational and it would make a great addendum to what we already have in the health pages.

HUGS.........JJ

PS That torture chair sounds so not fun!
Helpful - 0
1045086 tn?1332126422
Wow Sho.  I'm sorry this is how it went but really do appreciate the wonderful education you offer us here.  It would make an excellent back up page to Quix's trilogy of Health Pages re: urinating in a nutshell.

All in all it sounds like you have a winner of a urologist there.  Maybe because I'm usually a fan of starting with more conservative approaches.  I am sorry to hear that you are in a position of remolding your self-image for the future.  Those adjustments are difficult enough to contemplate in the abstract.   I can only imagine it's a true B*itch to maneuver in reality.  

Just wondering... Does the staff wear traditional medieval garb to complement that testing throne?

Thanks again and {{{(((BIG HUGS)))}}}
Mary
Helpful - 0
572651 tn?1530999357
Sho, I always appreciate your detached, clinical observations and the accompanying research to back up what you have to write.  I sure hate that you have this problem on top of every thing else.  ISC does make a huge difference for most of us and I hope you can figure out a technique that will work for you.  

Thanks for sharing these details.
hugs, L
Helpful - 0
Avatar universal
wow, everything we ever wanted to know and then some.
THANKS for the extreme details as I envision that my aging urologist
is going to want to go this route and it will be easier, knowing what
to expect.  I think I've had a modified test like this but not with the chair and the saline fill (make mine hi-test pls - grin).
Although it doesn't sound like fun, don't think I would dread it so much now.

At least you have some answers now!  Thanks for sharing
Helpful - 0
Have an Answer?

You are reading content posted in the Multiple Sclerosis Community

Top Neurology Answerers
987762 tn?1331027953
Australia
5265383 tn?1483808356
ON
1756321 tn?1547095325
Queensland, Australia
1780921 tn?1499301793
Queen Creek, AZ
Learn About Top Answerers
Didn't find the answer you were looking for?
Ask a question
Popular Resources
Find out how beta-blocker eye drops show promising results for acute migraine relief.
In this special Missouri Medicine report, doctors examine advances in diagnosis and treatment of this devastating and costly neurodegenerative disease.
Here are 12 simple – and fun! – ways to boost your brainpower.
Discover some of the causes of dizziness and how to treat it.
Discover the common causes of headaches and how to treat headache pain.
Two of the largest studies on Alzheimer’s have yielded new clues about the disease