Mets day 356 - A talk with my Uro

Today I had a long office visit with my local urologist.  He's associated with GWU.  I thought I was going to have a cystoscopy, but apparently when he heard that I had been able to self-catheterize regularly, he decided that he didn't need to do a cysto.  Instead, we reviewed in detail my ongoing nighttime incontinence, and what to do about it.  Interestingly, he said that he recently had decided to steer patients away from neobladders, because so many have ongoing incontinence issues.

I explained how I had tired every type of recommended neobladder management, including not drinking any fluids after 6 pm, self-catheterizing each night, regularly getting up at night to void, taking Ambien or Lunesta, etc., but I was still leaking, which would in turn jolt me awake.  He said that, with some people, continence just didn't happen.  I explained how my ongoing incontinence had essentially forced me to stop my law practice, because of the sleep deprivation.  I told him I was open to any solution.

He identified the following options, in ascending order of intervention:

1.  Do nothing for now, and see if it gets better with time (been there, done that)
2.  Do kegels and see if that works (been there, done that)
3.  Consider a drug option, such as Cymbalta (Duloxetine).  He referred me to his partner, who specializes in incontinence, and is more familiar with the latest studies on this option.
4.  Consider surgery, such as a sling, pouch, or an artificial urinary sphincter.  Again, for those, he referred me to his partner.
5.  Consider changing the neo to an IC or maybe a continent pouch.

I made an appointment to meet with his partner to discuss options 3 and 4.  The appointment is in a month.  He didn't want to give me a script for Cymbalta in the meantime, and I didn't press the issue -- if my doc isn't comfortable with prescribing a drug, I'm not going to press it.

So I'll just keep on grinding on in my grey haze until I am able to meet with the incontinence specialists at both Hopkins and GWU in early May, get both of their opinions, then decide what to do.