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Ask Dr. Arun Phophalia Your Own Question
Dr. Arun Phophalia
Dr. Arun Phophalia, Doctor (MD)
Category: Health
Satisfied Customers: 31611
Experience:  MBBS, MS (General Surgery), Fellowship in Sports Medicine
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Suddenly I am not able to urinate. A few weeks ago I had ...

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Suddenly I am not able to urinate. A few weeks ago I had this feeling all the time like I had to pee, but then I could hardly produce any urine. My urologist ran a urodynamics test that showed my bladder is still pretty full after I think I''m finished peeing - like 350 ml. full. But I can''t make it come out. He couldn''t give me a reason for it & said there''s no cure. I''m not old, and I''m in good shape. This has come on very suddenly & I''m disturbed by the fact that he can''t tell me why it''s going on. Can this resolve itself? Will my bladder explode? Is there anything I can do to make it better? He said I could catheterize myself. That sounds incredibly drastic to me. I just don''t know how to deal with this. Do you have any advice? I have spondylolisthesis - could a pinched nerve be causing this? Also I''ve been taking LOTS of calcium for osterporosis - could that cause this to happen?

Greetings.

Did your urodynamic study constituted uroflometry or/and cystometrography? Did they do ultrasound? What were the other investigations done? Did he do a digital rectal examination?

Dr. Arun

Customer: replied 8 years ago.
Reply to Dr. Arun Phophalia's Post: I don't know those terms. What they did before the urodynamics test was to look inside my bladder with a cytoscope. No tumors. Guess that's good. Then they did an ultrasound, which showed I wasn't retaining urine at that time (that was about 10 days before the urodynamics test). Things have gotten worse. The U. test consisted of filling my bladder thru a catheter, to various levels on a scale of 1-10 of how urgently it made me feel like I had to urinate. Then they told me to go ahead & empty my bladder. Then she used a syringe attached to the catheter to draw out the 350 ml that still remained in my bladder. They had a printout from a bunch of electrodes attached to various body parts, like my abdomen, a rectal probe, and thighs, which showed I was using abdominal muscles to squeeze out urine, and was not a good strong flow. Does this answer your question?

Yes, this does. One more question before we proceed to answer; did they ask you to urinate in a commode which was connected to a computer and which gives various urine flow studies? Before the test they ask you to full your bladder naturally.

Thank you.

Dr. Arun

Customer: replied 8 years ago.
I was instructed to come in with a full bladder. They had me empty it right away, but I don't believe the commode was attached to any sensors or computers. The graph that was made was done with electrodes all over me, after they had filled my bladder with the catheter.

Hello,

This can be Bladder neck dysfunction which is defined as an incomplete opening of the bladder neck during voluntary or involuntary voiding. This can be because of;

1) smooth sphincter dyssynergia,

2) proximal urethral obstruction,

3) primary bladder neck obstruction, and

4) dysfunctional bladder neck.

Evidence of outlet obstruction is easily obtainable by urodynamic study. Once obstruction is diagnosed, it can be localized at the level of the bladder neck by

a) video-urodynamic study, (you have got this although it was not a video)

2) cystourethrography during a bladder contraction, or micturitional urethral profilometry (you need to get it done).

The treatment would entail;

1) Alpha adrenergic blocking agent

2) Bladder neck incision (this would be done by cystoscopy).

Please feel free for your follow up questions.

Dr. Arun

Customer: replied 8 years ago.
I am going to have to look up all those terms... do any of them have to do with nerve signals? What about my question about the possibility of my bladder exploding? I read that bladder capacity is about 400 ml, and they told me I was retaining 350 ml. I'm extremely scared about all of this.

Hello,

I understand this is quite a medical jargon. I am sorry for this but all these, as you may understand, are difficult to give the simpler terms. You have correctly mentioned that bladder capacity is around 400-500 ml. But an ultrasound initially showed complete emptying of the bladder 10 days ago. Sometimes, when one is lying down, bladder neck dysfunction becomes more prominent, especially when one uses the abdominal muscles.

A urinating flow study (cystourethrography during a bladder contraction, or micturitional urethral profilometry) usually will able to identify the obstruction of the outflow. Bladder walls are quite elastic so they won't explode. Please don't worry about it. Most people, once started with the medications or after getting the bladder neck incision (a minor procedure) often note afterward that they have "never" voided as well. The combination of the studies I mentioned are able to identify the nerve dysfunctions and abnormalities. An MRI of the lower spine will sometimes needed, if any neurological problem is associated. The calcium intake is not associated with it. Although a spondylolisthesis, if severe, and depending on its level, needs to be evaluated by MRI, as I have already mentioned.

Please feel free, if you have further queries.

Dr. Arun

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