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Re: Severe bladder instability-- your thoughts??From: ainsron (ainsron@sbcglobal.net)Mon Dec 12 09:46:47 2005
Another Ob in town who does a fair amount of uro/gynecology also uses bladder instillation of Elmiron with good success, they respond a lot quicker than patients on oral dosing. Ronald E. Ainsworth, MD, FACOG -----Original Message----- From: Atkinson, Samuel M [mailto:ob-gyn-l@obgyn.net] On Behalf Of Atkinson, Samuel M Sent: Monday, December 12, 2005 7:11 AM To: Multiple recipients of list OB-GYN-L Subject: Re: Severe bladder instability-- your thoughts?? Glenn: You know all the answers in this pt but I enjoyed the presentation. Seems our group has not heard of the Parson's test with KCl. This will really light an IC patient up with pain. Need heparin and zylocaine available for bladder instillation if she is too uncomfortable. Hydrodistension , under anesthesia of course, is a quick way to treat the disease symptoms for a while and you can do the cysto at the same time. DMSO (RIMSO 50) is approved for bladder instillation by FDA for IC. This is a simple outpt instillation. First rule for any urogyn is to not do a sling (TVT) on small bladders. Of course you have been doing Tapes as long as I have and know that also. While other anticholinergics might occaisionally work in patients on low doses, oxytrol will not touch someone already on 15 mg Ditropan. Lastly, we give DepoLupron as a diagnostic test for endometriosis so why not Elmiron under the same pretext. _____ From: ob-gyn-l@obgyn.net on behalf of ENDODOK@aol.com Sent: Sat 12/10/2005 12:45 PM To: Multiple recipients of list OB-GYN-L Subject: Severe bladder instability-- your thoughts?? 56 yr old G2P2 with constant urgency, frequency, occasional urgency incontinence & mild SUI. Urethral inclination 30 degrees, positive Marshall test.No uterine prolapse, minimal cystocele. No UTI. Simple cystometrics: PVR 10cc, initial urge to void 20cc, strong urge @ 80cc, max capacity only 120cc. Has seen urogyn, Ditropan 15mg reduces Sx by only 30%. Urogyn had alluded to possible sling for SUI, but major complaint really bladder instability. Pt. is miserable. J. Glenn Bradley MD
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