Today I had an appointment with Hazel, a urology nurse at GW who specializes in pelvic floor issues. After we reviewed my pee log and discussed in some detail my recent problems with being able to void and increasing nighttime incontinence, she suspected that this was not an issue of a weak pelvic floor. After giving her a urine sample and trying to empty my neobladder, I assured her there was still a good deal of urine that was not coming out. She decided to catheterize me and find out how much was left. Oh, joy: I'm not a fan of catheterization. She was unable to get the first one into the neobladder, despite several gentle but still painful jabs. She found a smaller catheter, but after still more jabs, she was unable to get that one into the neobladder either. After checking with Dr. Fraizer, she did an ultrasound, so I hobbled from one room into the ultrasound room. The ultrasound confirmed that my neobladder had lots of urine, and also appeared to show two different reservoirs. Hazel told me that she suspected that I had a stricture -- a compression in my neobladder -- either because it was twisted, or from scarring due to the surgery.
Dr. Fraizer and his chief resident then did a cytoscopy. They snaked the scope through my urethra, and the camera showed that the top of the urethra where it joined the neobladder had scar tissue around it so that the opening was less than one millimeter wide -- about the thickness, he said of the wire of a paper clip. He had the image on a large monitor and was showing me the images and explaining it all to me. Dr. Fraizer said that explained why I was only able to urinate in short bursts - the compression of the neobladder would only push a little bit of urine through that small opening, then I'd have to squeeze again.
Dr. Fraizer then snaked a very thin guide wire through the cystoscope and into my neobladder -- the guide wire barely fit through the opening. He withdrew the cystoscope, leaving only the guide wire, then explained he was going to "punch a hole" through the scar tissue by pushing a series of catheters through it, each one larger in size. Question: How many catheterizations can Ken have in 30 minutes? Answer: 8! The first one was the most painful: the doctor had to literally push through the scar tissue, scraping some off, as the catheter tip passed from my urethra into the neobladder. After a couple of punches, Dr. Fraizer noticed my discomfort, and pushed some lidocaine into where they were doing their scraping. Note to doctors and nurses: As a general matter, application of pain-killer should precede infliction the pain.
The fun ended with another cystoscopy, and this time Dr. Fraizer was get it into the neobladder and look around. Everything looked fine, he said: no twisting or other scarring or other issues. The two different reservoirs as shown on the ultrasound was due to a particular viewing angle of the ultrasound, showing the upper and lower portion of the neobladder. He withdrew the cytoscope and inserted a Foley catheter so the top of the urethra could heal. I will go back on Monday to have it removed and see if I can now pee better. Dr. Fraizer said that we could flush the catheter and neobladder daily to ensure it did not get blocked by mucus. Just like the old days -- only two months ago!
Here I thought I was just going to have a nurse talk to me about kegels, and instead I'm there for nearly three hours to have my penis roto-rooted. Dr. Fraizer said that, in many cases, this single clearing of the scar tissue is enough, and no further intervention is needed. But I should be mindful of changes in how my body voids urine, and if I start spurting again, it could be a sign that the scar tissue is re-forming. Maybe it could be cleared again, or I may have to do daily self-catheterizations to keep it open. Doesn't that sound fun?
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ReplyDeleteI agree that anesthetics work better in advance. Sorry to hear of your unexpectedly crummy urology appointment; however, now that "Neo" has been roto-rootered, hopefully things will finally improve and you can get some sleep.
ReplyDeleteNobody wants to have to do self-caths, and I hope that you don't need to do them. However, many people of all ages do them several times per day. For them, it is like brushing their teeth or any other health maintenance habit. Try as best you can to keep a positive attitude.