Post Renal transplant advised for urethral dilatation
65 years female, actually my mother-in-law,who is a post renal transplant patient Chief Complaints She has been suffering from UTI several episodes in last few months Her doctor nephrologist has advised for a urologist opinion on getting a urethral dilatation done On telephonic consultation, urologist advised for a uroflowmetry and refused for a urethral dilatation seeing the report Management Kindly give your valuable opinion on uroflometry as my brother in law and myself are concerned, she is far away from me too, whether urethral dilatation is needed or not I am not good at reading uroflometry report too, if someone can teach me too😊😊
Dear dr Ajeet Pal Singh Uroflomatery do not show any obstruction as p/sec exertion approximately 20ml Recurrent UTI is a common complication in renal transplants as pt is on immunosuppressants catches infection secondaly she has one kidney only so total excretion is lesser At the most you can go for cystoscopy And sr creatinine
Uroflometry shows normal maximum for rate but below par average flow rate Decrease contractility of bladder muscle is one of the crucial cause of recurrent urinary tract infection, decreased average flow rate points to the same Adv For prevention of recurrent urinary tract infection 1) Tablet Bethanechol one tablet three times a day (avoid in case of asthma) 2) Tablet cranpac D (cranberry juice extract) one tablet three times a day 3) Strict control of blood sugar with insulin This will help in preventing recurrent urinary tract infection After starting Bethanechol , you can repeat uroflometry to look for improvement in shape for rate
My experience with uroflowmetry was not good They were not able to pass small procedural catheter Then I was on Foley's for 2 to 3 month with urotone25 qds Then after2 month realised flow will be ok One time I got uti Monthly changing of catherer Chance of uti increase Do usg prevoid post void urine Urine culture and sensitivity Then take opinion of nephro& uro
Generally the experience in females of this age group is much less than in males. However, the bulk of the urine is over in 20sec. So extrapolating the average flow rate is more like 7cc/sec. In males of this age the minimum rate for intervention for surgery and or medication is around 10/ sec. Also the machine this is done on is a basic machine . To conclude about the contractility of bladder is not possible.A cystometry and a Uroflowetry as a part of channel urodynamic study on a 4 channel machine like a status or a laborie unit would be more beneficial Considering that she is a post transplant she may also be a diabetic so a surgical procedure should be attempted with due caution. If she currently has an infection, I would certainly repeat a Uroflowetry after a course of antibiotics.Amd take the opportunity to so a Cystometry and a Uroflowetry in the same sitting. At the very least a repeat Uroflowetry on a more elaborate computer based system is advised.
Average flowrate I read as 4 but it is 8 .The advice still stands
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CHARAK SERIES Chapter -1 ( Sutra Sthana ) Deergha Jivitiya Adhyaya Respected Vaidyas, Glad to represent you the next series of Charak Samhita. My hearty thanks to all the readers and sincere request to rest of the Curofians kindly participate in this series to know the Classical Medical books with a different taste of Ayurveda. ......RECAP......... Till now we discussed - 1. The necessity of Ayurveda and its descendance in Earth. 2. Role of Great Sage - Bharadwaj in this descendance process. 3. Importance of AAROGYATA ( Healthy state of Body and Mind) 4. Knowledge transfer procedure from INDRA to BHARADWAJ about TRISUTRA Ayurveda. 5. Detailed description of TRISUTRA ( HETU, LINGA and AUSHADHA SUTRA ) and the convergence of whole Ayurveda in this TRISUTRA. 6. Comparison of TRISUTRA to WHY, WHAT and HOW for easy understanding and relationship between the three are also well established. Now is the time to go into further discussions and rapidly cover the rest portions of 1st Chapter. ........TODAY'S DISCUSSION......... The portions till now we covered in this series reflects that - Initially Earth was free from diseases and hence there is no such need of any science which can solve the problems related to health ( SWASTHA Sharira and Mana i.e. Body and Mind ). But gradually due to environmental changes ( Kala ) , Excessive / Nil / Less indulgence of Sense organs to its functions ( Artha) and Excess / Nil or Less involvement in activities of Body and Mind ( Karma ) by human beings leads to appearance of such conditions which disturb the harmony ( i.e. ROGA or DISEASES). As a result of this, the general public got disturbed and searched solutions to them. So they moved their attentions towards the Rishis or Saints who spent their life for the well fare of others and devoid of any worldly desires. Henceforth, gradually the Saints on behalf of the common public gathered together at Himalayan regions ( may be due to its popularity, holiness and abundance of medicinal plants ) and made several discussions but got no final solutions. So they undergo deep meditations and realised that INDRA is the saviour. They selected " SAINT BHARADWAJ" as their leader and he leaded the whole team, finally became the FIRST MAN who learnt TRISUTRA Ayurveda from INDRA ( The Purusha ). So " SAINT BHARADWAJ" is the BRIDGE between " SWARGALOKA AYURVEDA" and "MARTYALOKA AYURVEDA". I have written the above portions due to realise the importance of Saints ( the knowledgeable persons who always involved in the process of uplift of soul and worried for the well being of the Society ) and their Untiring efforts for the descendance of this unique medicinal system in Earth. ROLE OF SAINT BHARADWAJ ----------- " Tena Aayu Amitan lebhe Bharadwajah Sukhanwitam. Rishibhya Anadhikam Tat cha Shashansa AnabaSheshayan" ---------- After getting the knowledge of Ayurveda, Saint Bharadwaj implemented the RULES on himself and got " Amit" and " SUKHA" Aayu ( i.e. Indefinite Health ). Finally transferred the knowledge to other Saints for the well being of common public. This Shloka is being important because it indirectly denotes the qualities of a " GURU " or " VAIDYA" The qualities as I analysed are - 1. Shrotevya - Means having in-depth theoretical knowledge. 2. Dushta Karma - means having sufficient practical experience ( utilisation of theoretical knowledge) ( As Saint Bharadwaj himself learnt the knowledge deeply and applied on himself first ) 3. Anadhikam - Having no partiality i.e. Saint Bharadwaj shared the exact same knowledge which he gained from INDRA ( add nothing extra by his own ) 4. AnabaSheshayan - No feeling to hide anything i.e. Sharing the same knowledge which he himself got and experienced. ( i.e. I mean to say there is no SECRECY if we want to develop and uplift a Science) Saint Bharadwaj even not hide a bit but told the Same as he gained from " INDRA" So kind request to all Curofians kindly go into the depth of this Important Shloka and try to reflect in your attitude and behaviour to become a " VAIDYA ". This is the essence that I want to share with you all. Finally , Saint Bharadwaj spreaded his knowledge of TRISUTRA AYURVEDA to all the Saints who are interested and those Saints again spreaded his knowledge in their localities for the well being of humanity. !! Astu!! ............PRECAP .............. Tomorrow we will concentrate on Sad Padarth Vijnanam which again simplify the " TRISUTRA". Hope this article is capable of quench the thirst of knowledge gain. With this words for today, I give rest to my mind and pen. Thanks, With Regards, Vaidya Niranjan Ram.
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