Since my TURP three years ago, I have been unable to empty completely when I void. If I do (even when the Botox is active) I get severe pain/spasms that last 15-60 seconds, with a pain level of around 9-10 (on a scale of 0-10).
As I am prone to bladder infections, it is important to be able to empty, as this helps flush my bladder of bacteria.
I have seen two different urologists over the last three years and neither had any ideas as to the cause or possible treatments. Last summer my current urologist (after two years!) suggested a local pain management clinic.
The doctor at the pain clinic prescribed some "nerve calming" medications Neurontin and Lyrica.
After giving the medicines time to work, the doctor performed a hypogastric plexus block that was not effective.
The doctor increased the amount of Neurontin and changed the other medication to Trileptal. However, I have had to stop the Trileptal, as it made me feel like I had the flu.
His next step was to perform a lumbar plexus block, but after thinking about it decided that, because the hypogastric block was not effective, the lumbar plexus block probably wouldn't be either, and instead decided to try a caudal block.
A caudal block is administered to the nerves that leave the end of the spinal cord and branch out through eight small holes in the sacrum. These are sometimes referred to as sacral nerves. The caudal space is small "gap" in this bone just above the coccyx, or tailbone.
This block consisted of numbing the area first, then inserting a large-bore needle in the caudal space. Through this needle the doctor inserts a small catheter, and, while watching on a fluoroscope, positioned the tip of the catheter above each of the eight nerve bundles that exit my sacrum Even though it was pretty uncomfortable, it was fascinating to watch.
Once the tip was positioned and the position was confirmed using contrast, the doctor injects some numbing medicine and then a steroid.
The unfortunate side effect of a caudal block is that it temporarily removes ALL sensation and some control of the pelvic nerves, including the bladder, and removes the urge to void. My doctor warned me about this and cautioned that I may void on myself, which I did. I stayed in recovery about an hour and then was sent home with a diaper, which was not fun. As I'm able to self-cath, it was not a problem to keep my bladder empty until sensation returned.
The good news is I was able to void pain-free for at least a couple days! After this the medication wore off and the voiding pain returned. My doctor told me this would happen and it would take a couple of attempts until it was more permanent.
As there seemed to be some success with this block, I was scheduled for a follow-on caudal block about a month later.
I arrived on time and the nurse took me to the changing room. Everything off, gown on, IV started and the nurse the doctor would be in shortly to talk to me and then they would take me to the procedure room for the block
The doctor walked in an informed he was not going to perform the block! He cited the following reasons:
- Not enough pain relief.
- "Perceived" complications. (I have some oozing and ran a slight fever. This went on for a week and the nurse requested that I go the emergency room. The attending ER doctor did not think anything was really wrong, but gave me a shot of Rocephin (an antibiotic) just to be on the safe side.)
- Because I have some control over the pain, (if I don't empty) it is not a significant impact on my quality of life!
I agree it was his call to decide this. But, he had almost a month to decide this! He did not have to wait until I was literally on the gurney, waiting to be rolled into the procedure room, to tell me this. To this day, I don't know why this happened.
The good news is that the clinic where I see my current urologist has opened a pain clinic of their own. I have had one visit the pain management specialist there who seems very encouraging. She elected to try a different tactic on medication and has prescribed a muscle relaxant instead of the nerve medication the previous doctor used.
She also scheduled me for some physical rehabilitation with a pelvic floor disorder specialist (more on this later) and, as I seemed to have some relief from the previous caudal block, she is willing to try this again. So, maybe there is more good news on the horizon!
Published On: March 20, 2009