Urology (Uro) staff are experienced in bladder management of patients following spinal cord impairment (SCI).
Our staff include: Urologists, Doctors, a Clinical Nurse Specialist, Registered and Enrolled Nurses, and Technicians.
The aims of the service are:
Prevention of over distension of the bladder.
Prevention of infection.
Prevention of local damage to the urethra and bladder by instrumentation and artificial drainage.
Regular assessment and surveillance of the bladder and urinary tract to preserve the function of the kidneys.
Inpatients
The Urodynamics team will provide support and education on how to manage your bladder following a SCI.
The service oversees:
Management of all suprapubic, indwelling urethral and intermittent catheters.
Intermittent self-catheterisation.
Urine specimen collection.
Urinary appliance assessment.
Any other procedure which involves bladder or renal function.
Reassessment
Patients are readmitted to the Spinal Unit some months after discharge for Reassessment, which will include an assessment of current bladder management.
Patients are also readmitted for bladder surgery: including insertion of suprapubic catheter, bladder stone removal, sphincterotomy, flexible cystoscope, Botulinum Toxin, and bladder augmentation.
Outpatients
You will require a referral to the Burwood Spinal Unit from your GP, ACC Case Manager, or District Nurse for a Urology review.
Outpatients are seen for regular reviews of current bladder management.
Cystometry, Flowrates and Ultrasound residuals are performed by the nurses. Assessments of urinary drainage appliances and teaching of intermittent catheterisation may be done as an outpatient.
A Urologist is available for VCMG clinics once a week, Bladder surgery once a fortnight and an Outpatient Clinic once a fortnight. Flexible cystoscopy and Botulinum Toxin may be done as an outpatient.
Before your Outpatient Appointment
It is important to have a urine specimen for culture and sensitivity done the week before an outpatient appointment, and have the results sent to Urodynamics. This is so you can have appropriate antibiotics if required.
If you are unable to attend the appointment, please let us know as soon as possible.
If you are being admitted for a Reassessment and are having problems with your bladder management, it is a good idea to contact the Urodynamics Department as soon as you receive your admission letter. This will allow us to discuss your problems and try to have any further investigations booked for when you are admitted.
It is also a good idea to fill out a bladder diary for a week before you come to see us.
Urology Tests
Flow rates
A Flowrate is a non-invasive test to check the flow when you are passing urine.
An ultrasound residual is performed following the flowrate to check the bladder has emptied completely.
USS/X-rays
Renal Ultrasound Scan (USS) and X-Rays are recommended regularly to check for bladder and kidney stones.
They are usually requested prior to an admission for Reassessment.
They may also be recommended if catheter blockages are a problem.
Cystos
A Cystometrey (CMG) is a bladder test which is performed by the Urodynamics Technician and Nurses.
This test will show any bladder contractions or high pressures in the bladder as it fills.
It enables the medical staff to check whether your current form of bladder management is the most appropriate.
VCMG
VideoCystometrography (VCMG) is a bladder test very similar to the Cystometrey, but also involves the Urologist and an X-Ray Technician.
The bladder is filled with an x-ray contrast, which enables the Urologist to see what happens as the bladder fills. The test will show weakness or tightness of the bladder opening, or reflux back up to the kidneys.
This test allows the Urologist to assess whether your current form of bladder management is the most appropriate for you.
Cystoscopy/Flexiscope
A cystoscopy is a procedure that uses a flexible fibre optic telescope (very tiny camera) to look inside your bladder. This procedure can be done as an outpatient or may be done with general anaesthetic if the doctors feel this is more appropriate.
The Urologist will be able to see inflammation or changes in the bladder wall, bladder stones, and strictures (blockages) in the urethra.
Botulinum Toxin Injections for the Bladder
Botulinum Toxin can be injected into the bladder wall via a flexible cystoscope to partially "paralyse" the bladder and decrease bladder contractions and high pressures.
This may be done with local anaesthetic as an outpatient or you may be admitted for a general anaesthetic if the Urologist feels this is more appropriate.
Other Services - Catheter training
Intermittent Self Catheterisation (ISC) is the insertion and removal of a catheter several times a day as required. It is a safe effective way to completely empty your bladder, and means you will not have a catheter permanently in your bladder.
Intermittent Self Catheterisation can be overwhelming to begin with. With guidance from the Urodynamics Nurses, practice and patience, you will gain confidence and independence.
Change of Catheter /Bladder washouts
For those with indwelling catheters, the BSU recommends fortnightly catheter changes and weekly bladder washouts.
It is important not to let the catheter become blocked. If the bladder fills with urine and stretches it may cause systemic infection, which will require antibiotic treatment.
Autonomic Dysreflexia may also develop in a tetraplegic patient when the catheter becomes blocked – this is a life threatening situation and requires immediate intervention.
If the urine is treated with antibiotics, it is important to change the catheter 24hrs after the first dose with a new catheter.
Consumables: What's needed & How to order
to order
Prior to discharge from the Spinal Unit, the Urodynamics Nurses will prepare a "script" of all the consumables required for your bladder and bowel care e.g. catheters, gel, tape.
This is faxed to your ACC Case Manager, who approves it and sends it to their contracted distributor, who then couriers the consumables to you every 3 months.
If you are not on ACC, a letter is sent to the District Nursing Service requesting the appropriate supplies.
You will require a referral to the Burwood Spinal Unit from your GP, ACC Case Manager, or District Nurse for a Urology review. You are welcome to contact the Urodynamics Dept. for information:
Phone: 03 383 9850 or 03 383 9483
Ext: 99683 or 99483