Bladder Control

[SCIADVOCATE]

Patient lives in Los Angeles area. 19 months post injury. C5/C6 incomplete quad. Went to Craig Hosp for 3 1/2 months rehabilitation. Has had indwelling urethral foley catheter since day one. Patient wants to get off the indwelling and go to another method of bladder management. We have been to three urologists in the area and all three have different opinions leaving us very confused. Urologist #1 - Dr. David - says to leave indwelling in. Urologist #2 Dr. Ginsberg - says to inject botox in frozen parts of sphincter and move to external (condom) cath. No botox done as yet. Patient spent four hours in his office trying to void on his own with no success. After indwelling replaced, patient voided 1000 cc's of urine. Doctor was truly surprised that patient could not void on his own. And he is an SCI specialist. Later I found people online with SCI who said it was normal for an SCI person not to be able to void. Urologist #3 - Dr. Leach - says to absolutely get off the indwelling and switch to intermittent catheterization simultaneously with the use of Enablex. Patient has had numerous urodynamics tests. Used to get UTI's but has not gotten a UTI since taking D-Mannos. Someone online suggested we do some bladder training by clamping off the catheter tube for short periods of time. Patient is not able to cath himself but has 24 hour caregivers who can do it. Patient has Oxytrol patch for bladder spasms and once I pointed this out to Dr. Leach he then said patient did not need it and to remove it and take Enablex instead. Dr. Ginsberg wants to do flueodynamic test but Dr. Leach says it's the same thing as the urodynamic test. Both Dr. Leach and Dr. Ginsberg don't recommend the BladderScan 6100 which is a portable handheld ultrasound device that measures how much urine bladder is holding at any given time. Frankly, I think this would be helpful. In all the areas of finding help with spinal cord injury, urology has us completely stumped. It is troubling that there are so many differing opinions out there. I would so appreciate some input, especially if someone knows of a doctor or nurse in our area who knows all about bladder management with spinal cord injury. Thank you.