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Understanding operative report

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  • Understanding operative report

    I got to read my operative report. When I asked my Dr. after the Hydrodistention if he took pictures he said "there was nothing to see because it was too bloody" this confused me! In the operative report it says:
    " Th patient's capacity on the first fill was 300 ml and on the second fill revealed a confluence of petechiae throughout and glomerulations throughout all four quadrants." "The effluent following both fills was bloody." "it was more bloody after the second."
    Why would he not want to take pictures I would think that would be proof to the insurance that this is what I have.
    He also did 33 shots of botox. We are appealing the insurance, in hopes they will pay for this last treatment and more.
    Does anyone have any thoughts on this.
    IC/IBS Hopeful : I had my bladder removed on September 29, 2008 for me but I am also so happy I have no regrets

  • #2
    When they do a hydro, they do two fills. The first time, your bladder is filled and drained to determine bladder capacity and to induce glomerulations (bloody areas that are characteristic of IC). Then the bladder is filled again and the uro takes a look around to see what the inside looks like -- generally, they diagnose IC if they see the glomerulations and petechiae (speckles of blood) at this point. This second fill is sometimes called the "therapeutic distention" because they fill your bladder and hold it there for about 5 minutes (sometimes a little more) -- this is the distention that will help your symptoms IF you respond to hydros as a therapy.

    Bloody effluent is normal... that means the fluid drained out of your bladder after both distentions was bloody, and that's just because your bladder bled during the stretching. Mine did too, and you'll find most people here have that same report.

    My diagnosing uro (not the same one I have now) didn't take pictures either -- I wish he did for my own curiosity, because he said it looked terrible in there, but it's not required for most insurance companies.

    Now, the Botox... that one I have no idea about... hopefully someone who's had it will let you know.

    *Diagnosed with severe IC in 2004
    *Also diagnosed with PFD, fibromyalgia, chronic myofascial pain, IBS, migraines, allergies/asthma, dermatographism
    *Kept trying a million different treatments for all these things until I found what works, and I am doing okay these days with the help of a cocktail of medications and the InterStim, which was first placed in 2007. [I have had 2 revisions - one in 2010 when my battery died and had to be replaced, and one complete replacement (lead and generator) in 2012 after a fall on my stairs caused my lead to move.]
    *Current meds include Atarax (50mg at night), Lyrica (150mg twice a day), Xanax (0.5mg at night and as needed), Zanaflex (4mg at night), hydrocodone (10/325, every 6 hours as needed), Advair, Nasonex, Singulair (10mg at night), oral contraceptives, home instills containing Elmiron and Marcaine (as often as I need to do them).

    **I am not a medical authority nor do I offer definitive medical advice. I strongly encourage you to discuss your medical treatment with your personal medical care provider. Only they can, and should, give medical recommendations to you.


    • #3
      I didn't type out the whole report here, but he does mention 3 fills plus the flushing fluid when he did the botox injection. He never mentions why the first fill was done or the amount. It must have been like you said to see what it could hold or just to look inside. I can't wait to go to my next appointment. I have so many questions for him. I work in my PCP's office and it just so happened that my opertave report ended up in my teams (Case managements in-box) I have no idea who put it there, but I am glad I got to read it.

      I have got some great help from this site from women who had the botox done. One of them gave me a phone number to the Botox reimburesment solutions hotline. They are helping me gather the info I need to fight the appeal process. Dr.notes, letter of necessity, info about the trials and more info on botox. We should have all this stuff gathered this week and send it in wish us luck.
      Part of me wonders was it the botox or the hydro that helped me. I tend to think it is the botox. I can still only fill my bladder to 200cc (proof was in the ultra sound I had recently) residual only 35cc that wasn't to bad. My bladder is still painful at 200cc so I think the botox is the key. We will find out in 6 to 9 months when we repeat just the botox if we win the appeal.
      Thanky you for writing me.
      IC/IBS Hopeful : I had my bladder removed on September 29, 2008 for me but I am also so happy I have no regrets


      • #4
        They are actually suppose to take pictures. I did Not have the hydrodistention, but I had a regular cystoscopy done and my urogyne took pictures. My bladder was extremely inflammed and vascular. He said he was sure I had IC. I did not want to do the hydro after reading up on it and all the pros and cons.
        I do think your doc should have taken pictures though, just so that if you ever need to switch doctors, it is good to have pictures that you can show the other doctor. This way you wont have to go through the same procedure again. Most doctors will read a report and then say," oh, I have to see for myself".
        Anyhow, Also, you could have had a lot of blood because of the hydro itself. They stretch your bladder, and that could cause anyone to bleed. I cant even begin to think about what my bladder would look like after a hydro. I was all inflammed and vascular and that was seen just during a regular cystoscopy.


        • #5
          That is odd that pictures weren't taken. My uro took pics and also made an extra copy for me at my request. My gyn also took pics and showed them to me when I had a laparoscopy to rule out endometriosis, even though endo wasn't found.
          My op report from the hydro also tells how many ml I was distended. I can imagine you are anxious to see your dr and find out more!
          How are you doing now? Which symptoms do you think botox is helping?
          Best wishes...


          • #6
            I didn't get any pictures taken either...


            • #7
              you are right I can not wait for my next appointment. One of the first questions I have for him is why didn't you take pictures? the next question is is he doing another hydro the next time he does botox again.
              to answer you question about how I am doing. I am doing much better. I am about 50 % better as far as being uncomfortable. I still have some urge but can put it to the back of my mind where as before the urge was so strong I had to go pee or at least try (30) times a day. now I go maybe 8 to 12. much better.

              I am in the process of appealing my insurance for the botox treatments. We should hear something within the next 15 days. I will keep you posted
              IC/IBS Hopeful : I had my bladder removed on September 29, 2008 for me but I am also so happy I have no regrets