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Dr. Tharun
Dr. Tharun, Urology Resident
Category: Urology
Satisfied Customers: 3682
Experience:  MBBS, DNB surgery and presently working as Urology resident towards the degree of Urologist.
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My husband has MS and has successfully self catheterised 4

Customer Question

My husband has MS and has successfully self catheterised 4 times a day for many years. A cystoscopy showed no abnormalities in July. Now he is more often than not unable to pass a catheter through the sphincter of the bladder. His prostate is normal and can pass the catheter through this point. Is there a link with involuntary muscle and MS causing a spasm here. We saw a urologist yesterday and a continence nurse, neither of whom had answers or results. Help much appreciated.
Submitted: 3 years ago.
Category: Urology
Expert:  Dr. Tharun replied 3 years ago.
HI

Did the doctor or the nurse try to catheterize during the visit?

Is he on any prostate medications?

Any recent episodes of bleeding while catheterizing ?

Please let me know.

Dr.Tharun.
Customer: replied 3 years ago.

neither nurse nor urologist were able to pass a catheter.
Not on any prostate medications, I mentioned prostrate is normal.
No bleeding on catheterisation.
Please consider MS involvement with this problem.
Thank you
Expert:  Dr. Tharun replied 3 years ago.
HI

There is no fixed pattern of bladder dysfunction in cases of MS. The picture is usually mixed with majority getting bladder overactivity with some sphincter problems. Rest of the them get only sphincter problems or a weak bladder only.
And it is not uncommon to see that this picture changes over a period of time.

Inability to pass a catheter is usually due to an enlarged prostate or a false passage in the urethra.
A tight sphincter is not strong enough to stop the catheter not at least if the urologist is trying to do it. Very rarely do we find a sphincter not allowing the catheter.
So in this case I would suspect either an enlarged prostate or a narrowed urthera which is blocking the catheter from advancing into the bladder. The only way to diagnose it is by doing a cystoscopy. If there is a block or stricture, it can be corrected at the same time.
Otherwise a Retrograde Urethrogram has to be done with a dye. This will find the area of block and also the cause.Then a cystoscopy can be planned according to the findings.
If evrything is normal then medications to relax the bladder neck can be tried like flomax or uroxatral. Sphincter can be relaxed with Botox injections too if it comes to that.
I think you should discuss these possibilities with your doctor and request for a cystoscopy to diagnose the problem.

I hope this answers your question.If you have any doubts, please let me know.

Dr.Tharun.
Customer: replied 3 years ago.


I mentioned earlier that the inability to pass a catheter is intermittent, meaning over the course of a day sometimes he can pass the catheter normally and then not able to 3 or 4 times after that. that is why I am asking about this as prostate is NORMAL it is when the catheter reaches the bladder sphincter it is not passable. therefore logic sends me to thinking that the connection is with MS when the sphincter may go into intermittent spasm as it is an involuntary muscle when I compare the power of spasm in a voluntary muscle! it must be surely sufficient reason for no one to be able to pass a catheter if it is in spasm. there cannot be a shrinkage of the urethra if on other occasions the catheter passes into the bladder quite normally. he does not have a false urethra! cystoscope was carried out 2 months ago result, all normal.
you mention 2 drugs - please give me further details of suggested doses to relax the sphincter muscle.
yes we have discussed this at length with the consulting urologist, but I wish to have a second opinion as you can imagine how distressing a situation this is. Can you ask an associate who is an expert in MS for their opinion also please.
I understand the workings of the bladder well, but it is the MS connection I am worrying about as the problem is intermittent
I look forward to your reply soon please.
Expert:  Dr. Tharun replied 3 years ago.
HI

Sphincter is composed of both volunatary and involuntary muscles and there are drugs to relax the involuntary group only.

These are called alfa blockers - the most common of them are Flomax and uroxatral.
Flomax is tamsulosin - Dose - 0.4 mg once daily.
Uroxatral - Alfuzosin - Dose - 10 mg once daily.
Rapaflo - Silodosin - Dose - 8 mg once daily.

There are no medications to relax the voluntary sphincter muscle specifically, but there are drugs which have been tried to achieve this.This includes diazepam, Baclofen and dantrolene.These medications have to be discussed with your neurologist before starting .These are centrally acting drugs which has effect on the sphincter muscles too.

Next option is botox , which can parlayse the sphincter and get rid of the spasms.
Surgical sphinctertomy is also an option as the last resort to circumvent this problem.

I will still advise you to get a RGU at least- retrograde urethrogram before taking spasms as the cause of the whole problem.Sphincter spams may prevent the urine from emptying by the bladder, but reverse is very rarely seen.
Alfa blockers are easily available and if they are effective , you will get to know within 2-3 days. Alfa blockers would be nice way to start the therapy.

Dr.Tharun

Customer: replied 3 years ago.


If the prostate is normal and the problem of catheterising is intermittent why do you suggest that the problem is caused by an enlarged prostate gland. The alpha blockers you suggest are for the prostate enlargement.

I would be grateful for further explanation.

I look forward to your reply
I
Expert:  Dr. Tharun replied 3 years ago.
HI

I am not suggesting enlarged prostate, but there are other conditions like a small recess into which the catheter escapes intermittently and blocking it. These small recesses are possible when you are self catheterizing for long time. Over a period of time the there could be minor injuries to the urethra with out much obvious symptoms , but can manifest later.

The alfa blockers are actually smooth muscle relaxants of the sphincter and does not cause prostate changes. It increases the urine flow by reducing the sphincter resistance and not shrinking the prostate. There are other medications to shrink the prostate like avodart.
So these alfa blockers are used in any bladder outlet obstruction. That is the reason for its use in females too who don't have a prostate.

I hope this clarifies the doubt.

Dr.Tharun.

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