A retrospective study on female urological surgeries over the 10 years following spinal cord lesion

Abstract

Objectives: To evaluate the efficacy and safety over a 10-year period of any urological operations required by female patients with spinal cord lesions (SCLs). Methods: Retrospective study of urological surgeries from our database performed on females with SCLs from 2001 to 2002. Surgery efficacy for neurogenic lower urinary tract dysfunctions (N-LUTDs) was evaluated by comparing 7-day voiding diaries pre-and post-surgeries, while individual investigations were done pre-and post-surgery to evaluate urological complications. Drawbacks were assessed. Results: Thirty-eight out of 69 patients underwent one or more urological procedures. Twenty-one out of 42 patients with suprasacral lesions underwent interventions for N-LUTD. The main surgical treatment was endoscopic detrusor infiltration of botulinum-A (Botox 300 UI or Dysport 750 UI) performed 107 times on 15 subjects using aseptic intermittent catheterizations for neurogenic overactive bladder. Mean efficacy duration was 9.2 months. Six females with infrasacral lesions underwent at least one intervention for N-LUTD. Two females in each group underwent tension-free vaginal tape for stress urinary incontinence (SUI), reducing episodes per week of SUI by 490% after 5 years. The most serious urological complication was active vesico-ureteral reflux (VUR) in three patients, treated endoscopically with submucosal injection of Macroplastique. No VUR recurrence was detected during a 6-year follow-up. All bladder stones (five cases) and renal calculi (five cases) were treated with endoscopic transurethrally electrohydraulic lithotripsy and extracorporeal shock-wave lithotripsy, respectively. Overall, no serious drawbacks were observed. Conclusions: Mini-invasive surgeries were exclusively used to address urological issues in chronic SCL patients.

Comparison of bacterial strains and antibiotic susceptibilities in urinary isolates of spinal cord injury patients from the community and hospital

“…Pseudomonas and Acinetobacter species have already been known as established pathogens in general hospital-acquired infections, and the treatment of these species is a challenging task because of their limited susceptibility and the emergence of resistance during therapy. 11,12 Enterococcus species can also be possible UTI pathogens in hospitalized SCI patients, and have been known to be relatively more common in catheter-associated UTI. 8 Because of their inherent resistance to cephalosporin and aminoglycoside, specialized antimicrobial management should be considered in treating Enterococcal UTI.…”

Surgical management of the neurogenic bladder after spinal cord injury

“…TVT placement gave similar positive results in the few patients published in the literature [15]. Comparison between synthetic tapes and autologous sling remains difficult due to small series.…”

The pattern of urologic care among traumatic spinal cord injured patients

“…This is paradoxical given the importance female TSCI patients place on their bladder function 19 and the high frequency at which they undergo urologic procedures. 20 Reasons for this may be related to a tendency in patients to manage their bladder with an indwelling urethral catheter. The assumption could then be that the bladder is "treated," and no further urologic intervention or consultation is necessary despite the potential long-term complications associated with permanent catheterization.…”