Discussions that mention urecholine

Interstitial Cystitis (IC) board


NOTE: I have never asked a question on here before and am not looking for a "diagnosis" as that can only be done by exam, history, etc. This patient is a friend of mine with no insurance and I am looking to know if further evaluation is likely to turn up anything new or if it would be a waste of time and money.

I am a retired psychiatrist who knows a 31 year-old male with severe bipolar disorder who suffers from chronic urinary retention, frequency, slow and intermittent stream, and incomplete emptying x 14 years. Nocturia has been a problem in the past but no longer is, probably due to Remeron therapy for sleep. He was diagnosed with interstitial cystitis under general anesthesia cystoscopy and bladder distention with glomerulations present. Previous workups, including prostate exam, office cystoscopy, urodynamics were largely negative, though bladder ultrasound showed about 130 cc residual.

Patient was completely unable to void during video urodynamics on the table, making that test inconclusive. After being left in exam room alone for 45 minutes, patient was able to void in a sitting position. That urologist made a (guarded) recommendation of surgical correction of bladder neck obstruction based purely on the flow rate of his sitting void, which was 11.7 ml/second with no residual urine on repeat fluoroscopy. Fluoroscopy also demonstrated no reflux and smooth-walled bladder, which the urologist claimed argued against significant obstruction. However, some obstruction was felt to be present and an increase of Hytrin to 10 mg from a previous 5 mg was recommended, though the IC was diagnosed by another urologist several months later and Hytrin was not tried again.

His condition has, of course, been aggravated in the past by several anti-cholinergic psychotropics (particularly TCAs) and was generally unable to tolerate these without mutltiple doses of urecholine.

Today, patient is on Cymbalta 60 mg (which did aggravate condition for a while, then seemed to level off), Abilify 45 mg, Lexapro 10 mg, Remeron 30 mg, Xanax 0.5 mg BID, Zyrtec-D, Nexim 40 mg, Crestor 40 mg. Patient underwent 1 course of ECT x 5 years ago and maintenance ECT for a couple of years thereafter.

Previous therapies tried without success include Hytrin, Elmiron x 3 years (perhaps some benefit), Flomax, prostate massages (though no evidence of BPH or prostate cancer).Urecholine has been most effective, but, of course, has to be taken TID and the benefits are not THAT significant to seem to justify this. Sitting sometimes makes voiding easier and patient is TOTALLY unable to void at a urinal or with someone else in the room unless sitting and straining as if having a bowel movement.

Is there something else to try? It has been several years since a comprehensive urology exam, but prostate exams have been done in routine physicals. Patinet also recently had a tiny kidney stone (which passed when treated with Flomax). If he goes to a new urologist, what kind of guidance should ask for. As a psychiatrist, I am not an expert in urology but even the diagnosis of IC seems odd given the lack of pain. After MANY medication trials for bipolar disorder and ECT, patient is really tired of trying things just to try them. Is there something that is realistically possible?