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Urology/hypotonic blader , urinary urge


   iam a  male patient 52 years old suffering  from  hypotonic urinary bladder which was diagnosed 20 months back since then iam on intermittant self catheterisation 5-6times a day. The cause was diagnosed as bladder outlet obstruction for which TURP& BOO was performed but with little improvement.. Presently iam using Bethenecol 25mg TID without much improvement.
    Recently iam suffering form urge of urinartion even for 200 ml of urine in the bladder. This is impeding my routine and daily work considerbly.There are no other symptoms of infection, urine culture is negative repeatedly, antibiotics are of little use.  The urologist prescribed tryptomer 10mg TID. Can i use this drug as it has the side effect of diminishing the contractility of bladder. Is Fluexitine @20mg daily helpful or can I use tremadoal 5omg BID as both of them were suggested by another urologist.
  Are there any chances of recovary of bladder after several months after catheterisation? i request an anseer from you
         With regards

ANSWER: Govind:

The first thing to do is stop the bethanecol.  While it stimulates the bladder, it also stimulates spasms and unwanted contractions.

Antibiotics are not helpful because it's not an infection.

Tryptomer can sometimes help cases of chronic pelvic discomfort but won't help spasms.  

I cannot find fluexitine but there is a flurexitine which is an SSRI drug and is not likely to help with bladder spasms.

I cannot find any tremadoal but there is a tramadol which is a pain pill that might help a little.

While there is always a chance of recovery, if the bladder muscle is too badly weakened, it may not work regardless of treatment.  To know for sure, a bladder muscle pressure test can be done called a CMG or urodynamics test.  This will give better information about the current state of the bladder muscle.  Intermittent catheterization is a reasonable option in these situations.

---------- FOLLOW-UP ----------

QUESTION: Thank yu very much doctor.sorry for this delayed reply as i was away for working and unable to tract my mail box due to paucity of net facility. As per yr advice i stopped bethanecol and there is definite improvement.

iam presently using  10 F Nelton catheter as i found the urethra is narrowing at the level of prostate, at the beginning of urethra. I under went TURP 9 months back.Every time i use a catheter i am feeling pain and burning sensation at least for 10-15 mi after removal of catheter. my urologist prescribed tryptomer 10mg TID suspecting it as a nurogenic pain originating from prostate.can i use this medication as it has the potency to weaken already hypo tonic bladder. My urologist suggest that it is a canot cause any harm at this dose.Are there any alternate drugs to reduce these particularly trouble some symptoms.
  If narrowing of urethra to the extent of troubling self catheterisation after some months of ISC and making the regular catheters (no 12/14) very difficult to introduce, what are the possible causes and remidies . can a short term indwelling catheter with urine bag help to carry on with ISc normally at least for some more months.
         Awaiting for yr response


If you are having trouble placing the catheter and need to use only a #10, there is probably a stricture that may need further treatment so please notify your urologist.  In many cases, a small repeat surgery or dilatation may be needed.

The Netaton catheter usually is not self-lubricated.  If you can switch to a self-lubricated catheter it will likely reduce the pain and burning.

We do not use tryptomer here so I can't comment on it from personal experience.  If it seems to be helping, fine.

An indwelling catheter may give some temporary relief, but I doubt it would extend several months.


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Stephen W. Leslie, MD


Questions concerning erectile dysfunction, kidney stones and prostate disorders including prostate cancer. I have a special interest in kidney stone disease prevention.


Full time practicing urologist with 30 years experience. Associate Professor of Surgery and Chief of Urology at Creighton University Medical Center. Editor in Chief of eMedicine Urology internet textbook. Author of only NIH approved book written for patients by a urologist on the subject of kidney stones "The Kidney Stones Handbook". Inventor of the "Parachute" and "Escape" kidney stone baskets and the "Calculus" stone prevention analysis computer program.

American Urological Association, Ohio State Medical Association, Sexual Medicine Society

Men's Health, Journal of Urology, Urology, Healthwatch Magazine, Emergency Medicine Monthly, eMedicine, "The Kidney Stones Handbook", and numerous articles in various newspapers. He is also the editor of the Urology Board Review by McGraw-Hill used by urologists to study for their Board Certification Examinations.

Graduate of New York Medical College with residencies completed at Metropolitan Hospital New York, Albany Medical Center and University of Wisconsin-Madison.

Awards and Honors
Thirlby Award of the American Urological Association. Rated as one the country's Best Urologists by the Independent Consumer's Research Institute

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