Evaluation of different methods of bladder drainage used in the early care of spinal cord injury patients

Wyndaele, J J; Sy, W. A. De; Claessens, H

doi:10.1038/sc.1985.4

Cited by 21 publications

(10 citation statements)

References 11 publications

(6 reference statements)

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“…4 ± 7 CIC may not be as e ective if the bladder is hyperre¯exive with detrusor-sphincter dyssynergia. 4,6 When CIC plus anticholinergic program failed to create an adequate bladder volume with lower pressure during storage, bladder augmentation is generally considered. 8 The purpose of this study is to assess the possibility of augmentation cystoplasty to achieve safe long-term urologic management in SCI patients.…”

Section: Introductionmentioning

confidence: 99%

Long-term results of augmentation cystoplasty in spinal cord injury patients

Chartier-Kastler

Mongiat-Artus

et al. 2000

Spinal Cord

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Study design: Prospective monocentric follow-up study. Objectives: To assess long-term functional and urodynamic results of augmentation enterocystoplasty in spinal cord injury (SCI) patients with detrusor hyperre¯exia and re¯ex incontinence who failed to respond to conservative treatment. Settings: Department of Urology (PitieÂ -SalpeÂ trieÁ re Hospital, Paris, France), Department of Neurological Rehabilitation (Raymond PoincareÂ Hospital, Garches, France), Assistance Publique ± Hopitaux de Paris, University Paris VI and V, France. Methods: Prospective study of 17 SCI patients (four above T6 level, nine between T6 and T12, and four below T12) with history of refractory urge incontinence to pharmacotherapy. Partial cystectomy (subtrigonal for 15) was performed with Hautmann enterocystoplasty (15) or detubularized clam cystoplasty (two). Results: Mean follow-up was 6.3+3.8 years (range 1.25 ± 10.5 years). Fifteen of 17 (88.5%) patients were completely continent under self clean intermittent catheterization (CIC) (mean 4.6/day, range 4 ± 7). The remaining two patients with pudendal nerve denervation had persistent stress urinary incontinence. No operative complications were noted. Long-term complications included recurrent pyelonephritis for one patient. Maximal cystometric capacity increased from 174.1+103.9 to 508.1+215.8 ml (P50.05). Maximal end ®lling pressure decreased from 65.5+50.2 to 18.3+7.9 cm H 2 O (P50.05). Conclusion: Urodynamic evaluation and clinical assessment demonstrate long-term success of augmentation enterocystoplasty in an homogeneous population (SCI) without delayed complications in SCI patients. Spinal Cord (2000) 38, 490 ± 494

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Section: Introductionmentioning

confidence: 99%

Long-term results of augmentation cystoplasty in spinal cord injury patients

Chartier-Kastler

Mongiat-Artus

et al. 2000

Spinal Cord

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“…(1) Informed consent must be obtained from SCI patients for TOM. (2) Check whether the patient will be able to wear a penile sheath and the sheath will stay in place when the patient is sat up on the chair.…”

Section: Discussionmentioning

confidence: 99%

Flawed trial of micturition in cervical spinal cord injury patients: guidelines for trial of voiding in men with tetraplegia

et al. 2003

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Study design: A retrospective study. Objectives: (1) To raise awareness of flawed trial of micturition (TOM) in male spinal cord injury (SCI) patients; and (2) to present guidelines for trial of voiding in male SCI patients. Setting: Regional Spinal Injuries Centre, Southport, UK. Methods: Trial of micturition in male SCI patients refers to discarding indwelling catheters and establishing them on balanced voiding with penile sheath drainage. We describe seven SCI patients, whose trial of micturition was flawed. Results: Two patients (C-6 and C-4 tetraplegia respectively) developed severe autonomic dysreflexia (headache, sweating, and increase in blood pressure) 2-3 h after removal of urethral catheter. A C-4 tetraplegic developed severe urinary infection after TOM. Four patients with tetraplegia started retaining increasing amounts of urine and developed urinary infections/ autonomic dysreflexia/hydronephrosis 1-21 months after they were established on sheath drainage after TOM. Conclusion: During TOM, patients with cervical SCI could develop autonomic dysreflexia, urinary infection, or hold progressively increasing volumes of residual urine. TOM should be guided by videourodynamics. SCI patients need a-blockers, and anticholinergics if voiding pressures are 440-50 cmH 2 O. If high urethral resistances are found, sphincterotomy and/or bladder neck incision will help the patients to void by triggering. SCI patients, who had undergone successful TOM, require meticulous follow-up including urodynamics. Intermittent catheterisation without adequate medications based on cystometrogram may be hazardous, and may result in upper tract damage. Facilities for supplementary catheterisation (three to four times a day) should be available in the community if a patient is unable to maintain complete, low-pressure, emptying of bladder.

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“…Where IDC for longer than 6-8 weeks is antici pated, an alternative, such as suprapubic fine-bore catheterisation, may be a better alternative and should be considered more often; studies with its use in recent years have shown encouraging results. 18,19 As the purpose of this paper is to establish some guidelines for the frequency of radiological surveillance during the lifetime of the SCI patients, no attempt has been made to establish a relationship with variables such as inefficient bladder emptying, high detru sor pressure, disturbance of bladder com pliance, and/or high resistance to urinary flow. It should be appreciated that uro logical complications in patients who are catheter free are influenced by these factors.…”

Section: Discussionmentioning

confidence: 99%

Review of urinary tract abnormalities in 100 patients with spinal cord paralysis

Gupta

Chawla

1994

Spinal Cord

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The importance of long term follow up of neurological status of patients with spinal cord injuries is well recognised. Although there is a general agreement about continued radiological surveillance of these patients, there is lack of uniformity of approach and guidelines as to how frequently such screening should be undertaken and for how long it should be continued. The present study, following analysis of clinical and radiological data of 100 sequential patients, indicates that morphological complications of urinary tract are common (63% in patients studied) and that a significant number (70-75%) develop complications within the first year following onset of spinal cord dysfunction.The development of these changes appears to be related to more than 8 weeks of presence of continous indwelling catheter during patients' initial bladder management. The study further suggests that the risk of developing demonstrat able abnormalities after 10 years of normal radiology is very small (approxi mately 1%). It is, therefore, suggested that patients with spinal cord paralysis should have surveillance of urinary tract annually for 10 years and that the follow up beyond 10 years should be determined by clinical necessity rather than a fixed protocol.

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Evaluation of different methods of bladder drainage used in the early care of spinal cord injury patients

Cited by 21 publications

References 11 publications

Long-term results of augmentation cystoplasty in spinal cord injury patients

Long-term results of augmentation cystoplasty in spinal cord injury patients

Flawed trial of micturition in cervical spinal cord injury patients: guidelines for trial of voiding in men with tetraplegia

Review of urinary tract abnormalities in 100 patients with spinal cord paralysis

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