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Urology/hypotonic bladder, cisc , recurrent infections.

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Question
Dear doctor,
        Thank You very much for the  kind responses. I am a male 53y,Indian, suffering hypotonic urinary bladder  resultant of  symptom less & neglected  long standing BOO. Two surgeries were performed . First one is Outlet incision with TURP without any response but left behind distorted and high neck outlet  which made ICSC quite painful . The second surgery  was performed  to make easier passage for ICSC.
     The present problem is recurrent infections. I experienced two infections  with in 10 months after second surgery. On both the occasions they occurred two days after catheterization which were uncommonly painful . Further tightening of bladder neck, difficulty in passage of catheter are being experienced one month after antibiotic treatment, followed by painful catheterization and then infection.Presently iam on oral ABT treatment from past 3 days, (cefixime) running 99F temperature with pain and spasms during and briefly after catheterisation.
     After the first surgery, though cathing is painful and difficult,I never experienced single infection for 14 months , but they appears to be increased  only after second surgery. Is this due to post surgical thinning of the protective mucosal barrier of op site and easy exposure to truma? If that is the case what may be the alternative to reduce the truma and postpone the infections?   Presently I am using 12F Nealton catheters and occasionally 10F with adequate lubrication.. Is shifting to 10f catheter completely reduce the chances of infection? My urologist suggests cytoscopy and if possible trimming of residual tissue . The very idea of any other invasive procedure and further prospects of   urethral damage really petrifying me.
  At what point of infection  I/v antibiotics are recommended? Are they really better than oral ones. Is consuming lots of fluids necessary to flush off infection & Is uri-bag for a short term of 5-7 days recommended in my case  during treatment for infections or can I increase the frequency of  cathing.
 Can i use flavoxinate/ NSAIDs for a short time of two days to ease pain . My bladder still retains some contractions with which i can void (small quantiites) when there are no infections
         Truly yours
         K.GopalaRao

Answer
Gapalarao:

You have a more complex situation than the standard.  The reason for your recurrent infections is most likely due to your underlying bladder problem and not from the surgery doing anything to the protective mucus of the bladder lining.  The passage has to be open to allow for easy ICP.  You should not have to go to a 10 French catheter.  Perhaps a coude tip would help.  A cystoscopy to look at the passage and see if there is any new blockage might be a good idea so I agree with your urologist.

If there is a correctable problem regarding the bladder neck that is contributing to the infections or making catheterization difficult, it's usually a good idea to have it fixed.  

IV antibiotics are indicated when oral antibiotics don't work or if the underlying infection is considered severe enough to warrant it such as 104 temp, fever, chills or sepsis.  IV antibiotics are not "better", but are appropriate for the most severe infections.  

Lots of extra fluids to increase urine output is a good idea.  A uribag is probably also a good idea but 5-7 days doesn't help; either use one all the time or forget it.

Use of other anti-spasm medications may or may not be a good idea; ask your physician.

You might benefit from an ultrasound of the kidneys to make sure there are no stones, some extra vitamin C to help acidify the urine and make it less prone to infection, and possibly some long-term, low dose urinary antiseptic like mandelamine or nitrofurantoin. Ask your physician about these possibilities.

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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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