KUB Ultrasound For December 2010

Report for the KUB (kidneys, ureters and bladder) ultrasound done on December 27, 2010 at UMMC:

Indication:
Neurogenic bladder with renal parenchymal disease.

Findings:
Comparison made with previous ultrasound dated 11.2.2010.
Both kidneys are increased in echogenicity. Right kidney measures 8.6 cm in bipolar length and left kidney measures 9.1 cm in bipolar length. A small cyst is seen in the right kidney, measuring 0.5 x 0.5 cm. No renal calculi or hydronephrosis. Urinary bladder is underfilled and the wall is trabeculated.

Impression:
1. Echogenic kidneys which may represent parenchymal disease.
2. Renal right cyst.
3. Trabeculated bladder wall.

Generally, I would say that there is little change from the previous ultrasound. That is good news for now. Together with the slightly better results for the renal profile done on August 2010, I am happy. These are good news to close the year with.

On Detrusitol SR 4mg Capsules Again

Detrusitol SR 4mg prolonged release capsule
Detrusitol SR 4mg prolonged release capsule.

After one year on a twice daily dosage of Detrusitol 2mg tablets, the University Malaya Medical Centre pharmacy has switched me back to the Detrusitol SR 4mg extended release capsules again. For unexplained reasons, the pharmacy stopped dispensing the SR 4mg.

Detrusitol in the prolonged release capsule form is more convenient as I need to take it only once daily. Unlike the previous SR capsules which were packed seven capsules to a blister strip, the current ones come loose in 30s to a small plastic container. The new capsules appear smaller in size too.

I have been taking Detrusitol either in 2mg tablets or 4mg prolonged release capsules since 2004 when I was diagnosed with chronic renal failure. This is to relax my overactive bladder and the frequent urge to urinate, and in turn, reduces the risk of a reflux of urine from the bladder back to the kidneys, which if left unchecked will cause further damage to them.

First Urodynamics Study

For all the years that I have been living with spinal cord and chronic renal failure, I have not had a urodynamics study done to determine the pressure in my bladder. This test is needed to determine whether the pressure in the bladder will cause a reflux and further damage to the kidneys.

I had one done at SJMC last Saturday for once and for all as to see if the pressure in my bladder is the cause of my renal failure and whether I need further treatment. I have been waiting to get it done at UMMC but two appointments were cancelled. The first time was because the urologist was away and the second because the urodynamics clinic was under renovation.

All garbed up at SJMC waiting for the urodynamics study to commence
All garbed up at SJMC waiting for the urodynamics study to commence.
Photo by Wuan.

There is usually a six-month waiting period at UMMC but it would have been done free of charge there as I hold the Kad Orang Kurang Upaya from the Department of Social Welfare Malaysia. It costs RM1,500 at SJMC. Another urodynamics study was schduled for mid-June at UMMC but I thought I better get it done first at SJMC just in case the one at UMMC gets cancelled again.

The procedure was not as embarrassing as I had anticipated. The technician was very patient in explaining the entire procedure and made me feel at ease even though I was bare-bottomed throughout. A thin tube was inserted through the urethra into the bladder and another into the rectum. The tubes were connected to a device that fills up the bladder with saline at a pre-determined rates – 30ml/min and 15ml/min, measured the pressure in the bladder as it filled up until urine started to leak.

The equipment used for the urodynamics study
The equipment used for the urodynamics study.
Photo by Wuan.

Another device was placed right below my seat to measure the amount of urine that leaked. After that, the residual urine in the bladder was sucked out with a syringe and measured. The results showed that the presurre in my bladder is normal until the volume is around 300ml where the pressure rises to slightly more than 50cmH2O and the fluid started to leak. The leaked volume was around 100ml while residual volume was around 200ml.

According to the urologist, as long as I keep up with my three hourly intermittent catheterisation programme, it should not be a cause for concern as reflected by the results. No further treatment or medication is necessary. He recommended that I get the urodynamics study done every two years. He also checked the lump in my scrotum which has gotten smaller after a two-week course of antibiotics. I am to go back to see him in two months to get the lump checked again.