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Urology (Expert Forum)
Urinary Surgery
Questions in the Urology forum are answered by Dr. Stephen Liroff, affiliated with the Henry Ford Hospital. Topics covered include benign prostate disease, penis curvature, cystisis, kidney stones, pediatric urology, prostate, sexual dysfunction, urinary tract infections (UTI), and urological cancers.
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Urinary Surgery
by Stine, Sep 22, 1999 12:00AM
I am a 45 year old female diagnosed with CNS Vasculitis in December 1992. In December 1995, the vasculitis affected my bladder and resulted in being diagnosed as a neurogenic bladder. I am currently taking 30mg of Ditropan XL. This is the maximum amount for this medication. I must self cath to empty my bladder. I am currently taking Cytoxin by mouth which requires me to drink lots of fluids. When I go out in public, I have to wear a leg bag because I experience frequency and urgency from my bladder. I would like to know if there are any surgeries that could help or correct the frequency and urgency? Can the bladder hold more if the muscles are strengthened with the Keggel exercise? Has anyone with a neurogenic bladder from a neurological disease ever had the bladder return to normal?
Doctor's Answer
by HFHS M.D.-BE, Oct 05, 1999 12:00AM
Dear Ernie,
Neurogenic bladder is a difficult problem to live with, especially when the usual medications fail to treat it adequately. Sometimes, clean intermittent catheterization in addition to medications may help improve symptoms. The use of surgery is often the last resort, since surgical approaches have lots potential short and long term risks and complications. The usual procedure is to increase the functional bladder capacity by using a piece of bowel or stomach and attaching to the bladder. This in effect augments the capacity of the bladder allowing it to hold more urine under a lower pressure than prior to surgery, thus helping improve the symptoms of urgency and frequency. The procedure is referred to as augmentation cystoplasty. You need to discuss this in detail with a urologist, and understand the pros and cons well before embarking on such treatment. There is a new procedure involving the implantation of a nerve stimulator that may also help (in place of an augmentation).
Given your longstanding history of neurogenic bladder due to CNS vasculitis, it is unlikely that your bladder problems would spontaneously remit.
As you probably know, Cytoxan is toxic to the bladder and causes urgency and frequency on its own. There is a drug available to help prevent the bladder toxic effects. Discuss this with the individual prescribing the Cytoxan.
You should see a urologist to discuss your options. The best of luck to you.
This information is provided for general medical information purposes only. Please consult your physician for diagnostic and treatment options pertaining to your specific medical condition. Dr. David Burks at our institution has experience in incontinence and nerve stimulator and I would highly recommend that you see him for your problem. If you would like to make an appointment], please call us at 1-800-653-6568. We can also arrange local accommodations through this number if this is your need. Please bring any x-rays [and pathology slides] (not just the reports) as well as any physicians’ notes and lab test results that you may be able to obtain. These will help us greatly.
Sincerely,
HFHS M.D.-BE
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