Saturday, September 19, 2009

Catheters Gone Wild!

About three weeks ago, BR's suprapubic catheter went on strike. No amount of fiddling with angles and pushing and pulling would make the liquid sunshine flow through the tube without also flowing through his urethra.

On the first visit to the Mad Urologist, BR's normal latex catheter was replaced with a silicone "large lumen" model, in the hopes that bigger would equal better flow. Unfortunately, the nurse botched the insertion. Being made of a stiffer material, the catheter found itself exiting the bladder via the urethra. Can you guess what came next? Go ahead, guess. That's right. Balloon inflation in the prostate! After he realized something had gone wrong, the nurse called the doctor, who corrected the tube placement, and gave BR a two day Levaquin prophylaxis to keep the bacteria in his bladder from spreading to his blood stream.

Long story short, BR bled from his urethra for a week, the catheter only briefly worked well, and it hurt like hell when it was removed two weeks later.

Next, the Mad Urologist ordered video urodynamic tests to better understand what's happening when BR leaks. These tests are only done in their Round Rock office, which is about a 30 minute drive from home. For such a horribly uncomfortable suite of experiments, I have to say that Tracy, the nurse technician, made the experience as enjoyable as possible.

The tests showed that BR's bladder contracts in the presence of a very small volume of liquid, and that when it contracts, it does so with more than twice the normal pressure. Combine this data with the theory that the end of the catheter is migrating down to the bladder neck where urine can't get to it without a contraction, and we seem to have an explanation for the symptoms.

The Mad Urologist offered four options:
  1. Try a catheter with a "coude" tip which when properly inserted may be less likely to migrate down to the bladder neck.

  2. Insert a foley catheter through the urethra in addition to the suprapubic catheter. Double your pleasure. Double your fun.

  3. Inject Botox into the bladder muscles to reduce the strength of the contractions. Lighter contractions may permit more of the urine to exit through the catheter.

  4. Surgically close the bladder neck, forcing all urine to exit through the suprapubic catheter. The Mad Urologist is reluctant to do this because it limits his future options should BR develop other urinary tract problems, like stones.
So we are going to start with the coude catheter, which has been ordered and should be here sometime next week. If that doesn't work, BR says sew the bastard up.


Herrad said...

Hi BR, Hi Steve,

Bloody hell hate reading this latest problem with the catheter.

I actually winced in pain when I read how painful it was when it was removed.

Really hope there is a painless solution soon.

Hope you both have a good weekend despite everything.
Thinking about you.
Love and big hugs.

Cranky said...

Steve - oy. Hope the coude catheter does the trick. Is there anything that can be done to keep the catheter from wandering?

steve said...

Hi Cranky - I'm thinking we need to embed a magnet under the skin where we want the tip of the catheter to stay, and then use a catheter with a metal tip. Now who sounds like a mad urologist? :-)

Herrad, darlin' - We have been liming all day.

Kim said...

What's the timeline for the coude catheter? I hope BR can find some relief soon.

Much love to you both,

B ILL said...

I think Botox sounds like a Texas style solution. Maybe the Bladder could get a fancy date with a cute hottie catheter that would want to spend some time in there...

steve said...

KimmieG - The catheter is finally on its way. Funny thing - BR accidentally gave the tube a good tug last night. Painful, yet it is flowing better than it has in quite a while. Makes me a bit hopeful that the coude could work.

Billy - If he goes with the Botox, you know he'll put any leftovers to good use.