Dr. Raja Ramesh
Urology
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Patient's Query
Hi doctor,
I have secondary progressive multiple sclerosis. I am a 37 year old male. My weight is 165 pounds and height is 6 feet. My neurologist is treating my MS with two rounds of Rituximab infusions (low dose chemotherapy) every six months and a twice-daily dose of an Ampyra capsule. I also take Cymbalta (for depression), Ropinirole (for restless leg syndrome), Magnesium, and Vitamin D. I suffer from urinary incontinence. I have to use a catheter to urinate, and lately, I have been getting blood in my urine and on the catheter after I remove it. My question involves possible treatments for this. I have frequent UTIs and trying to come up with a way to stop this cycle. Is there any artificial valve that can be surgically placed in the urethra to control when my bladder releases consciously? I read something about a surgical valve replacement used in prostate cancer patients who have had their prostate removed. A control for this valve is placed in the scrotum, and the device apparently replaces the natural valve. I am curious if this surgery could be adapted to treat my incontinence.
Hi,
Welcome to icliniq.com.
Multiple sclerosis is a progressive disease. So with time, incontinence may change in either direction, positively or negatively. The best option is what you have been doing. It is called CIC (clean intermittent catheterization). It is adaptable to all stages of disease progression. Artificial urinary sphincter is ideally indicated only in the stable disease like post-prostatectomy incontinence where there will be no progression after two to three years. So, I would not recommend it for multiple sclerosis. Regarding urinary infection, it is bound to occur in anyone on CIC. It needs treatment only when you have symptoms like pain, hematuria, frequency, dysuria, etc. Antibiotics based on the urine culture needs to be given. Once you are asymptomatic, then daily low dose prophylactic antibiotic can prevent repeated infection.
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Urology
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