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Urinary Disorders

Urinary Retention and Chronic Kidney Pain

08/03/2011

Question:

I am a 40 year old mother of 4 . I`m on propanalol 80 mg daily for high blood pressure and trimethoprim for recurrent but unconfirmed UTI s.

I had a rectocele repair 15 years ago. My urinary flow has been progressively slow for years but never caused a problem. About 5 years ago I developed right flank pain which after about a year in bed one morning I realised it was my kidney and associated with full bladder . I was by then straining some to empty my bladder. straining over last few years has become a real effort. I have to bare down big time to empty my bladder and try all sorts of positions. urine is usually cloudy and offensive with culture usually negative but always has raised White cell count and debris +++. At worst i guard my bladder as it feels bruised . it is always worse on my right side almost as if I feel my right urethra hurting. only ever my right kidney aches and mostly after I urinate but also when my bladder is full. 2 kidney scans have been normal, except that pre void my bladder held 250 mls and post void volume was 95 mls .I assume the kidney pain is urinary reflux ? I had a cystoscopy under GA 2 days ago and the gynaecologist said he would dilate my urethra if it was narrow so was really hoping this was the cause of my symptoms. however he did not need to do this and cystoscopy was entirely normal . don`t have an appointment to see him for 3 months and I`m at the end of my tether. Really can`t empty my bladder properly. my kidney hurts all the time and I feel sick and fed up. I do have a prolapse again but the doctor said as this was a posterior wall prolapse it would have no effect on my bladder. I don`t drink plenty as this actually makes it worse. I have arrived 3 times for urodynamics testing but each time the nurse has sent me home because there is leucocytes and nitrates etc in my urine ! I keep trying to tell them that I was NEVER arrive without these symptoms because I cant empty my bladder but they can`t test because I always have an infection. it a viscous circle. I would appreciate your opinion and know you cannot diagnose on notes alone . I just feel like I am waiting for my kidneys to actually be harmed before anyone will take notice and I am already very young I feel to be on blood pressure medication. I would very much appreciate your thoughts and wonder if maybe I should seek a private consolation with another specialst? many thanks for your time.

Answer:

Yes, you most definitely need to see a different specialist.  A nephrologist (a medical, not surgical, kidney doctor) would be a good person to start with.  It sounds like you do have difficulty emptying your bladder, not caused by a narrowing of the urethra, but perhaps by some problem with the muscles of the bladder (called a "neurogenic bladder").  This is, as you point out, causing urine to collect in the bladder, causing inflammation and low-grade infection, and perhaps inducing reflux up your right ureter.  Your right-sided pain, continuously cloudy urine, and high blood pressure are all serious warning signs that you may be experiencing kidney damage, so the cause needs to be corrected before you go into kidney failure.

Has anyone tried just putting a catheter into your bladder and completely draining it?  Patients whose bladders don't empty well can be taught to catheterize themselves several times a day to at least get the symptoms and inflammation under control.  After several days/weeks of this, other procedures (such as the urodynamics that you clearly need) can be performed.  It also sounds like you might benefit from a different antibiotic than trimethoprim, perhaps one with a broader spectrum of activity.  

Good luck, and please write back to let us know what happens. Do not delay, because it is important to preserve every bit of your kidney function!

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Response by:

Mildred   Lam, MD Mildred Lam, MD
Associate Professor of Medicine
School of Medicine
Case Western Reserve University