Making Plans (Part 2)
A video urodynamic study is a test that shows what happens to the bladder when filling and emptying. I had waited along time for this procedure so was keen that all should go well but also anxious about the outcomes.
Before the appointment I needed to complete a three day bladder diary, detailing input and output so the specialists could see how much I was drinking and urinating. I was also to attend the appointment infection free, another course of Trimethoprim sorted that out but I was already starting to get a little round up. Another pre-requisite was that my bladder be full at the start of the procedure.
Video Urodynamic Study
The day came and as I sat in the waiting room my discomfort and anxiety rose to ridiculous levels. Once greeted by a nurse, directed into a cubicle and changed into a gown and pair of paper pants I began to see the lighter side of life.
“Patrick Boothman” I was called and ushered into a small room filled with some sort of gigantic, chunky looking x-ray machine, 2 nurses, my consultant and an x-ray operator. After pleasantries were exchanged the stages of the process were explained before we started. Step one was to empty my, near rupturing, bladder into a “flow-meter”. The “Flow-meter” looked suspiciously like a digital kitchen scale with a large white funnel balanced upon it. This snazzy bit of kit measured the volume and force with which I passed urine into it. I did so and everything seemed acceptable considering my situation. The next stage in the process would involved my body being laid on the large, flat, grey surface of the x-ray table. I was to have two fine tubes (supposedly containing some sort of pressure sensor inserted into my bladder (via the front) and rectum (via the back passage). The tubes allowed both cavities to be filled with a harmless fluid at a controlled rate and monitored pressure inside and outside the bladder whilst urinating. Even upon visual examination of my abdomen it was clear that my bladder had not emptied properly. My bladder has an adjoining diverticulum. Whilst the bladder is surrounded by muscles that can squeeze urine out, the diverticulum is not. The volume of x-ray visible liquid needed to fill the bladder and adjoining diverticulum would be considerable.
With the tubes inserted I stared up at the ceiling as my bladder was filled up with radioactive fluid that the x-ray operator tried to get a focus on. My responsibility was to let the nurses know what sensations my bladder nerves were conducting. Was my bladder filling up? Was my bladder half-full? Would I be looking for a toilet about now? Throughout the consultant had been observing the image of my bladder and diverticulum slowly filling up. Once full the computer image was adjusted so that I could clearly see the comparative size between bladder and diverticulum. Last year the unwanted cavity had measured the size of a 7 year old shoe. It now looked like it was the same size as my bladder! Had it expanded?
My questions would have to wait, first of all I had to “void” whilst the fluid dynamics were being observed. Which sounds easy but I was lying down on an x-ray table with tubes inside me. How on earth?
With the click of a button the behemoth of a table on which I lay started to whir and very slowly bring itself towards the vertical. With the camera positioned at 90 degrees to my bladder, with my bladder now at 90 degrees to the horizontal, staff would be able to observe what happens inside me when I urinate. Once again the kitchen scales appeared, this time they were not on the floor but held in the hands of the consultants assistant. Upon the given instruction I was to get as much urine a possible into the funnel whilst the consultant observed my inner workings. Ordinarily my aim is pretty good but with a tube inserted into your penis accuracy becomes more a concept to believe in rather than anything you are physically capable of. Urine went everywhere other than the intended target. On a positive note, at no time during the dribbling did urine travel back up my ureters towards my kidneys.
Whilst the nurses mopped up the mess and removed tubes the consultant and I discussed the next stage. The size of the diverticulum was so large that it would interfere with the results of any test. The first thing, note: not the only thing, but the first would be to remove the diverticulum. This would involve an abdominal incision similar to a cesarian section that would involve a short stay in hospital and a long recovery. Making rapid calculations in my head I realised there was no chance of fully healing before my Surf/Yoga trip to Morocco in November. I was just going to have to be patient and wait till the end of the year for my operation.
Plan 2 Achieved.
I felt massively received to have had somebody confirm that I was in a chronic condition and in need of medical attention. My only concern was enduring the time till the operation. With the summer holidays starting shortly I knew the kids would help me keep mind off things.
Plan 5; To get an operation.
More information about Videourodynamics; http://emedicine.medscape.com/article/1948113-overview
More information about Diverticulum: