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2 Urodynamics casesFrom: Paul Prior MD (pprior@clover.net)Fri Sep 29 00:08:32 2000
White woman, early 50's, recent diagnosis of multiple sclerosis, presents with complaints urinary incontinence. Physical exam shows mild hypermobility of U/V neck. Large volume leakage with minimal strain. Uroflow basically normal, perhaps a bit delay/dyssynergy. Urethral closure pressure is low - 17 and 25 measured. Leak point pressure also low 47 I think and 67 I measured. Post void residual was 300 cc. Culture pending, but presume negative. Seems to have quite a few issues here. My thought is to pursue timed voiding and perhaps intermittent self-cath as first line therapy (which I know she will hate and probably refuse to do). I'm reluctant to consider a sling/TVT given her likely progressive neurological process, but appears she does have ISD. She is on a combination diuretic for HTN and I would like to see her d/c this. Hoping maybe you experts (John?) might pipe in on your preferred management of those with M.S. and incontinence. Role for tricyclics at all? Anything new with detrussor stimulants? (All these numbers off the top of my head - more info available if requested) ------------------ second case - won't bother to present the details, but basically an ------------------ older (70's) woman very healthy who had initial hyst and unknown -- ------------------ bladder procedure, followed by retention and dilation. Then developed worse incontinence (was originally SUI, turned into constant dribbling after dilation) and was sent to urologist. He did a sling of some type but no improvement. Then collagen with minimal change. She gave up until she came to see me - all the above was 5-7 years ago. She leaks continuously all day long. Wears rubber pants.
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