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Urology/Intermittant self catheterisation bladder neck spasms

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Question
Respected doctpor,
Iam a 54 yrs male patient of hypotonic urinary bladder  due to long standing  unidentified primary outlet obstruction and prostatomegaly and two surgeries three years back to correct them failed to revive the bladder and iam on ISCC 5-6 times a day using a 12F PVC catheter and xylocain jel.iam lubricateing the catheter liberally and instilling gel into urethra till overflowing observed, closing the urethral orifice,keeping the shaft in upright position, waiting for 5 minutes and then inserting the catheter.However I am experiencing  painful spasms of bladder neck every time during catheterisation.This still persisted even i shifted to catheters with polished eyelets. intially the spasms are not often but of late they increased to a regular incidence. The pain though brief, is severe as long as the catheter is inside and disappears once it is removed. My urologist discounted them as inevitable part of ISC and prescribed treyptomer 10mg BID which is of no use. there is no evidence of infection and urine is clear, no smell, not chills or fever. Long term use of cipro as per the advice of my doctor is of no use. please advice me.  
         truly
         Koduri

Answer
Koduri:

The cause of your discomfort is unclear.  It may be spasms which can be corrected with medication, but a cystoscopy or telescopic examination of the passage might be a good idea first.  There could be a stricture or a chronic prostate infection that might be involved. You might need to get a second urology opinion from a different specialist if you are not getting anywhere with your current physicians.

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Stephen W. Leslie, MD

Expertise

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

Experience

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.

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

Publications
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.

Education/Credentials
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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