Early urological care of patients with spinal cord injury

Welk, Blayne; Schneider, Marc P.; Thavaseelan, Jeffrey; Traini, Luca R.; Curt, Armin; Kessler, Thomas M.

doi:10.1007/s00345-018-2367-7

Cited by 49 publications

(72 citation statements)

References 35 publications

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“…This phase resolves as early as 2 weeks, with an average of 8 weeks, and can be prolonged up to a year [6] . The extent and duration of this phase are variable and depend on the extension and the completeness of the spinal injury [12] . During this phase, Figure 2.…”

Section: Early Phase After Sci (The Spinal Shock)mentioning

confidence: 99%

“…Expected lower urinary tract dysfunction based on the level of neurologic insult (adopted from Panicker et al [5] ) conducting a urodynamic study had been considered of limited clinical value [6] . Recent evidence has shown the presence of adverse urodynamic findings in those patients in the early phase (within 40 days of the injury) [12] . The best management at this phase is to ensure complete bladder drainage by intermittent catheterization (IC) or an indwelling urethral catheter [6][7][8][9][10][11][12] .…”

Section: Early Phase After Sci (The Spinal Shock)mentioning

confidence: 99%

“…Recent evidence has shown the presence of adverse urodynamic findings in those patients in the early phase (within 40 days of the injury) [12] . The best management at this phase is to ensure complete bladder drainage by intermittent catheterization (IC) or an indwelling urethral catheter [6][7][8][9][10][11][12] . Once the patient is stabilized medically, a trial of spontaneous voiding along with post-void residual measurement or self-intermittent catheterization, if the patient cannot void spontaneously, should be tried, while admitted in a rehabilitation facility [12] .…”

Section: Early Phase After Sci (The Spinal Shock)mentioning

confidence: 99%

“…This will take place at the first consultation and includes: detailed history, physical examination, bladder diary (often catheterization record), post-void residual, urinalysis and culture, renal function assessment, and upper urinary tract imaging [6,8,12] . Urodynamic assessment and cystoscopy may be indicated at the first evaluation, depending on the stage of evolution of the neurogenic bladder dysfunction.…”

Section: Initial Urological Evaluationmentioning

confidence: 99%

“…Social history and social support, history of alcoholism or drug abuse are also important for long-term management. History of bowel management, past medical history of acute angle glaucoma, uncontrolled hypertension, and myasthenia gravis should be elicited as it might be a potential contraindication for medications that can be used for the treatment of NDO [6,12] .…”

Section: Historymentioning

confidence: 99%

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Evaluation, treatment, and surveillance of neurogenic detrusor overactivity in spinal cord injury patients

Alsulihem¹,

Corcos²

2019

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Neurogenic detrusor overactivity is a common urodynamic finding in patients with supra-sacral spinal cord injury. Early evaluation, stepped management, and close follow-up reduce the risk of upper urinary tract deterioration, renal failure and incontinence. In this article, we aim to outline the modern pathway of the management of this complex disease. Evaluation of patients with history, physical examination, renal function assessment, cystoscopy, and urodynamic study are essential. Management of neurogenic detrusor overactivity with adequate bladder drainage, medical therapy, intradetrusor botulinum injections, and surgery can be offered in a stepwise manner. Follow-up after specific interventions should be done in a timely fashion to detect treatment response and to avoid complications of poorly managed neurogenic detrusor overactivity.

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Section: Early Phase After Sci (The Spinal Shock)mentioning

confidence: 99%

Section: Early Phase After Sci (The Spinal Shock)mentioning

confidence: 99%

Section: Early Phase After Sci (The Spinal Shock)mentioning

confidence: 99%

Section: Initial Urological Evaluationmentioning

confidence: 99%

Section: Historymentioning

confidence: 99%

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Evaluation, treatment, and surveillance of neurogenic detrusor overactivity in spinal cord injury patients

Alsulihem¹,

Corcos²

2019

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The early, long‐term inhibition of brain‐derived neurotrophic factor improves voiding, and storage dysfunctions in mice with spinal cord injury

Wada

Yoshimura

Kurobe

et al. 2020

Neurourology and Urodynamics

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Aims We examined the time course of urodynamic changes and the effect of the short or long‐term inhibition of brain‐derived neurotrophic factor (BDNF) from the early phase after spinal cord injury (SCI) in mice. Methods The spinal cord of female C57BL/6N mice was completely transected. We examined filling cystometry and bladder BDNF levels at 10, 20, and 30 days after SCI, with an additional day‐5 measurement of BDNF. In a separate group of mice, anti‐BDNF antibody (Ab) (10 µg/kg/h) was subcutaneously administered using osmotic pumps from day 3 after SCI, and single‐filling cystometry was performed at 10 and 30 days (7 and 27 days of treatment, respectively) after SCI. Results Compared to spinal intact mice, bladder mucosal BDNF was increased at each time point after SCI with the maximal level at day 5 after SCI. Voiding efficiency was lower at each time point after SCI than that of spinal intact mice. The number of non‐voiding contractions (NVC) during bladder filling was gradually increased with time. In both 10‐ and 30‐day SCI groups treated with anti‐BDNF Ab, voiding efficiency was improved, and the duration of notch‐like intravesical pressure reductions during voiding bladder contractions was prolonged. The number of NVC was significantly decreased only in 30‐day SCI mice with 27‐day anti‐BDNF treatment. Conclusions Overexpression of BDNF is associated with the deterioration of voiding efficiency after SCI. The early‐started, long‐term inhibition of BDNF improved voiding dysfunction and was also effective to reduce the later‐phase development of detrusor overactivity after SCI.

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Using conjoint analysis to measure the importance of psychosocial traits in the choices of bladder management after spinal cord injury

Welk

Myers

Kennelly

et al. 2021

Neurourology and Urodynamics

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To conduct a conjoint analysis experiment to better understand the psychosocial priorities related to bladder management in individuals after spinal cord injury (SCI). Methods: We developed a conjoint analysis survey that included 11 psychosocial attributes phrased in the context of bladder management (including attributes for urinary infections, and incontinence). We then performed a multi-center prospective cross-sectional study of adults with existing SCI which consisted of a baseline interview, followed by the online conjoint analysis survey (delivered through Sawtooth software). Hierarchical Bayes random effects regression analysis was used to determine the relative importance of the attributes.Results: A total of 345 people complete the study. There was good representation of both men and women, and individuals with cervical and thoracic or lower lesions. The most important attribute was the frequency of urinary infections. Age, sex, and level of SCI were generally not related to the attributes measured in the study. In the subgroup of 256 patients who used a catheter for bladder management, significantly more importance was placed on urinary tract infections, time, fluid intake, and social life among indwelling catheter users compared to intermittent catheter users.Conclusions: Most bladder-related psychosocial priorities are not impacted by a patient's age, sex or level of SCI. Differences in psychosocial priorities between indwelling and intermittent catheter users may represent factors that should be focused on to optimize bladder management after SCI.

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Early urological care of patients with spinal cord injury

Abstract: Careful clinical assessment and pertinent urological testing including urodynamic investigation are necessary for appropriate counselling and treatment of new SCI patients.

Cited by 49 publications

References 35 publications

Evaluation, treatment, and surveillance of neurogenic detrusor overactivity in spinal cord injury patients

Evaluation, treatment, and surveillance of neurogenic detrusor overactivity in spinal cord injury patients

The early, long‐term inhibition of brain‐derived neurotrophic factor improves voiding, and storage dysfunctions in mice with spinal cord injury

Using conjoint analysis to measure the importance of psychosocial traits in the choices of bladder management after spinal cord injury

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