"Temporary" shy bladder and pre-employment DOT

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helent
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"Temporary" shy bladder and pre-employment DOT

Post by helent » Fri Oct 25, 2019 10:15 am

A current municipal employee is required to perform DOT-regulated job functions and was sent for DOT pre-employment drug testing. He provided a urine that the collector described as "oily" and was asked to provide a second specimen under direct observation. He stayed the three hours and was unable to provide an adequate volume.

He did speak with the MRO and did not provide any history that might suggest an explanation. Subsequent to that, he provided a note from a urologist with a diagnosis of stricture of the urethra, with the note also indicating this was a permanent condition. The MRO spoke to the urologist and explained the circumstances of collection, i.e. the initial "oily" urine. The donor's visit to the urologist was the first visit and the diagnosis was made by history. The urologist apparently did instrument the individual and upon questioning, did state that after instrumentation, the condition should not be classified "permanent" although he also added the condition could recur. The urologist "explained the oily urine as possibly being from congestive prostatitis secondary to primary condition. Urologist did an exam for signs of recent drug use and found none.

Interesting case and urologist opinion ...

Based on a urologist's opinion, this event would be accepted as a medical explanation and the test cancelled. This would also be a temporary shy bladder.

Should the donor be sent for a pre-employment test with an observed collection (because he was in that process when the shy bladder event occurred)? Or a regular collection?

And what if donor chooses to say the instrumentation was insufficient (during the observed collection) and he still is unable to void? A uroflow study would likely help in that case. But the concern is this could be an ongoing recurrent diagnosis and "reason" for inability to provide, as needed.

Is an observed pre-employment test collection a reasonable request? What is the next step in this case?



Robert Swotinsky MD
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Re: "Temporary" shy bladder and pre-employment DOT

Post by Robert Swotinsky MD » Sat Oct 26, 2019 3:53 pm

Repeat the DOT pre-employment urine test. A temporary shy bladder does not trigger a directly observed collection procedure.

If the donor fails to provide a sufficient specimen, have him return to the urologist. I think recurrent urethral stricture is an indication for surgical repair. Ask for the urologist's office notes - not just a letter report. If the urologist says it's a problem that's indefinite (e.g., pending surgical repair), arrange for clinical evaluation for drug use and do a hair or oral fluid test as part (perhaps the major part) of that clinical evaluation.

Prompted by this question, and by the new HHS oral fluid Guidelines, I offer the updated flowchart below that applies to urine and oral fluid:
insufficient specimen evaluation flow chart.gif
insufficient specimen evaluation flow chart.gif (27.67 KiB) Viewed 562 times

DrCRZ
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Re: "Temporary" shy bladder and pre-employment DOT

Post by DrCRZ » Fri Nov 01, 2019 12:40 pm

On the similar situation. I have a donor who came in to the collection site for a DOT and a non-DOT PCT testing. The collector did the non-DOT -PCT testing first , which was negative. The donor was not able to provide adequate amount on the second collection and a shy bladder log was started. Failed to provide adequate specimen after 3 hours and consuming the required max amount of fluid. I feel this whole collection should be cancelled since it was wrong from the beginning and an immediate recollection ordered. Is that the right action?

Robert Swotinsky MD
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Re: "Temporary" shy bladder and pre-employment DOT

Post by Robert Swotinsky MD » Fri Nov 01, 2019 3:47 pm

The DOT test is supposed to be done first because DOT says so. Nevertheless, the failure to provide a urine specimen after 3 hrs w/fluids offered does trigger a shy bladder evaluation for the purpose of determining if there is a medical reason for inability to provide the urine specimen and if so, is it permanent or temporary?

DrCRZ
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Re: "Temporary" shy bladder and pre-employment DOT

Post by DrCRZ » Tue Nov 05, 2019 10:09 am

Thanks Doc. Just feel bad for the donor in a way. Had the collection been done the correct way then the DOT part would have been over and the non-DOT which the employer have certain control over to recollect or not and bypass shy bladder evaluation would be left for us to deal with, but it is what it is.

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