A Serious Medical Concern or Just a Snapshot in Time?

Yesterday, we went to see Bob's urologist. This is a new urologist as Bob's former urologist has retired. And I'm really not sure if I like this guy...

Anyway, this was just a "six month follow-up" appointment, and the doc comes in and asks how everything is going and I tell him "fine", because truly, everything seems fine and Bob's been peeing like a racehorse.

So we talk for a minute and I mention something about Bob's condom catheter (which was probably a stupid thing to do, because I know this doctor is no fan of condom catheters, it was Bob's former urologist who prescribed those) and at that point, the doc jumps up and suddenly decides he wants to immediately do a sonogram on Bob's kidneys and bladder.

Oh-kay.

So I haul Bob back into some little, dinky, totally wheelchair-unaccessible room to have the sonogram done. Then I haul him back to the other room to wait for the doctor.

The doc comes back all flushed with excitement, and this is (you might remember) the speedy urologist who always talks fast-fast-fast, and he tells me that this is "just terrible" and that Bob has 570 ml of urine in his bladder and he shouldn't have more than 250 ml and this could cause renal failure and that could be fatal!

OK, now I'm a bit freaked out. Which is an understatement. As I'm really freaked out. Then the doc asks Bob if he can urinate? But doesn't give Bob time to answer. And then he tells Bob to empty his bladder, NOW! And he says "take all the time you need" and he leaves the room.

And I'm thinking, this is going to be impossible. As Bob usually cannot pee on command. But I ask Bob if he understood the doctor and when Bob shakes his head "no", I tell him that the doctor wants him to pee. Now. Does he think he can do that? Bob says, "I'll try."

So, I wait a few minutes and, lo and behold, Bob is actually able to pee. I can see around 100 ml in his catheter bag, plus there is more in the tubing, but that's not enough to bring him down to 250 ml in the bladder. So I ask Bob to try some more and he does, but he can't.

Then the nurse comes in and asks if we've had "success" and I tell her we did. Then they bring in a "bladder scanner" and rescan Bob's bladder and this time it reads 370 ml. Which is still too high.

Then the doc comes back and tells us that it's still too high. And he goes on and on about kidney failure and etc. and tells us that we have three options to consider, the first which is some kind of electrical gizmo that he could surgically implant in Bob's buttock that would send electrical pulses to the bladder and that might do the trick or, option #2, is to get a Foley or indwelling permanent catheter, or, last but not least, I can do intermittant catheterizations three times a day until the end of eternity.

Jeepers! None of these options sound good. And I certainly do not want to put Bob through more surgical procedures. And not to mention the co-pays, etc. So, I am sort of sitting there dumbfounded. The doc sees this and says that, well, we don't have to make a decision today. There's time to think about it, if that's what you want to do. Because, really, Bob is in no great danger at this moment, the danger of renal failure is more like five to ten years from now...

So, phew! I think, we'll think about this. And I tell the doc that and then he says, good, I'll see you next month and you can give me your decision then! GA! Then he tells me to "make sure" that Bob "empties his bladder" before the next appointment and we'll do another scan.

So we leave the doctor's office at about 2:30 p.m. and Bob can tell that I'm worried and he grabs my hand and says, "Don't worry. I'm fine."

We get home around 3:00 and at 3:15 p.m., Bob pees. I empty his catheter bag which reads another 100+ ml.

And at 4:30, he pees again. This time 200 ml.

Add that up, and since the 1:30 p.m. scan that read 570 ml in his bladder, Bob has now peed out 500 ml of urine.

Which means, if we had had that doctor's appointment at 4:30 p.m. instead of 1:30 p.m., the bladder scan would have only recorded 70 ml in his bladder --- as the last time I gave him fluids through his peg tube was at 12:00 noon --- and that doctor would not have been concerned at all...

Hmmmm.....

So is this really a serious medical concern? Or just bad timing with that scan?--a snapshot of 1:30 that day, which doesn't mean it's like that always...  And/or, did I give him too much water at noon?

Inquiring minds would like to know!

And truth be told, I have no clue what to do now....

Thoughts? Anyone?