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Re: bladder neck? From: john miklos (johnrmiklos@yahoo.com) Thu Feb 3 20:36:22 2000 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Joanne Bulley, MD: "Re: bladder neck?" Previous message: Jim Connerth: "Possibly more bad news---" In reply to: Robert J Woolley: "bladder neck?" Next in thread: Joanne Bulley, MD: "Re: bladder neck?" Robert, Though some suggestions previously mentioned might be correct...stone, CT, etc.....I would tend to agree this patient probably has an irritation possibly diet induced. It sounds as if this patient might have 1) sensory urgency syndrome or 2) bladder overactivity without incontinence. Her problem is probably a sensitive bladder with spasms and a very functional urethra with good resistance thus preventing incontinence. If a patient like this came to my office....I would perform a uroflow, check a postvoid residual (probably the most important piece of information)and perform a simple cystometry. As long as she is empying her bladder and there is no underlying reason why we should believe that she is not, I would RX her as if she has sensory urgency syndrome (Initial treatment is the same as if she has Detrusor Instability).....begin with an anticholinergic are antispasmolytic medication--I perfer --Ditropan XL. Begin the patient on Ditropan XL 5 mg and strict timed voiding. If after 4-5 days she does not begin to improve then increase the dose by 5 mg every 5-7 days. Continue dose titration until the patient begins to improve --the dosage may be increased up to a max of 30 mg. Few patients need more than 10 or 15 mg. The beauty of this first line of therapy is that it remains simple and benign. Ditropan XL 5 mg will be effective in approx. 25%, 10mg effective in 55%, 15 mg effective in 75% It is highly unlikely that this patient has IC since it has only existed for 10 days and she does not present with nocturia. At Thu, 3 Feb 2000, Robert J Woolley wrote: > >I have a generally healthy (but highly anxious) young woman (age 24) with >urinary urgency and frequency for about 10 days, no dysuria, no hematuria, >no vaginal symptoms, not pregnant. Urinalysis completely normal, urine >culture negative. She saw one of my partners first and was treated with >Bactrim and Pyridium, in spite of the negative UA; no change in symptoms >with these two meds for 3 days, no change upon discontinuing them, >either. She can hold her urine as long as she needs to (no incontinence), >but it requires constant voluntary effort, starting roughly 10 minutes >after last urination. Urine volume is proportionate to the duration she >waits. No problem at night. > >The best that I could reason from this was that she was having weakness at >the bladder neck, akin to stress incontinence, but constant instead of >only with stress, but with sufficient reserve in the pelvic floor muscles >(she has never been pregnant) to prevent actual loss of urine. > >Does this sound plausible? If so, is there a name for it? > >I tried treating her with pseudoephedrine as an alph agonist, no >response. Today I told her to try phenylpropanolamine, for the same >reason. If this fails, what would you do next (besides send her to a >urologist)? -- john miklos Next message: Joanne Bulley, MD: "Re: bladder neck?" Previous message: Jim Connerth: "Possibly more bad news---" In reply to: Robert J Woolley: "bladder neck?" Next in thread: Joanne Bulley, MD: "Re: bladder neck?"

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