Neurogenic bladder in patients with traumatic spinal cord injury: treatment and follow-up

Abstract

Study design: Multi-center, cross-sectional study. Objectives: Our aim was to evaluate the treatment methods and follow-up of neurogenic bladder in patients with traumatic spinal cord injury retrospectively using a questionnaire. Setting: Turkey. Methods: Three hundred and thirty-seven patients who had spinal cord injury for at least 2 years were enrolled from six centers in the neurogenic bladder study group. They were asked to fill-out a questionnaire about treatments they received and techniques they used for bladder management. Results: The study included 246 male and 91 female patients with a mean age of 42±14 years. Intermittent catheterization (IC) was performed in 77.9% of the patients, 3.8% had indwelling catheters, 13.8% had normal spontaneous micturition, 2.6% performed voiding maneuvers, 1.3% used diapers and 0.6% used condom catheters. No gender difference was found regarding the techniques used in bladder rehabilitation (P40.05). Overall, 63.2% of patients used anticholinergic drugs; anticholinergic drug use was similar between genders (P40.05). The most common anticholinergic drug used was oxybutynin (40.3%), followed by trospium (32.6%), tolterodine (19.3%) darifenacin (3.3%), propiverine (3.3%) and solifenacin (1.1%). The specialties of the physicians who first prescribed the anticholinergic drug were physiatrists (76.2%), urologists (22.1%) and neurologists (1.7%). Only four patients had previously received injections of botulinum-toxin-A into the detrusor muscle and three of them stated that their symptoms showed improvement. Most of the patients (77%) had regular follow-up examinations, including urine cultures, urinary system ultrasound and urodynamic tests, when necessary; the reasons for not having regular control visits were living distant from hospital (15.3%) and monetary problems (7.7%). Of the patients, 42.7% did not experience urinary tract infections (UTI), 36.4% had bacteriuria but no UTI episodes with fever, 15.9% had 1-2 clinical UTI episodes per year and 5% had X3 clinical UTIs. The clinical characteristics of patients with and without UTI (at least one symptomatic UTI during 1 year) were similar (P40.05). The frequency of symptomatic UTI was similar in patients using different bladder management techniques (P40.05). Conclusion:The most frequently used technique for bladder rehabilitation in patients with SCI was IC (77.9%). In all, 63.2% of patients used anticholinergic drugs, oxybutynin being the most commonly used drug. Also, 77% of patients had regular control visits for neurogenic bladder; 42.7% did not experience any UTIs.

Testing of a New Portable Device for Dynamic Bladder Pressure Monitoring

“…Detrusor pressure increases as the low compliance bladder is fully filled, the growing pressure is considered to be further harmful to renal function, which might finally cause renal failure . The foremost target of treatment for SCI patients with NB is to maintain the detrusor pressure in the period of storage as well as micturition in a security range and for the purposes of protecting renal function . Urodynamics is an important approach of diagnosing, treating and effective evaluation for bladder dysfunction .…”

“…8 The foremost target of treatment for SCI patients with NB is to maintain the detrusor pressure in the period of storage as well as micturition in a security range and for the purposes of protecting renal function. 9 Urodynamics is an important approach of diagnosing, treating and effective evaluation for bladder dysfunction. 10 However, this method has some disadvantages.…”

The pattern of urologic care among traumatic spinal cord injured patients

“…The vast majority of patients, especially those in this cohort who all underwent significant inpatient rehabilitation, will need some type of urinary device for voiding. 16 While there are obvious situations that would mandate a urology consult, there are also important potential screening tests and preventive counselling that urologists are well-suited to offer. There are demonstrated advantages in terms of quality of life 17 and complication rates 18 with certain methods of bladder management -for these issues, a discussion with a urologist may help patients make a fully informed decision about the investigation and management of their bladder.…”

Description of Urological Surveillance and Urologic Ultrasonography Outcomes in a Cohort of Individuals with Long-Term Spinal Cord Injury

“…10 A higher incidence of UUT abnormalities was associated with the use of a suprapubic indwelling catheter in this study 10 and with transurethral catheter use in another long-term follow-up study. 11 Previous studies in other countries have reported a variable adherence to the available urological surveillance guidelines [12][13][14][15] and just few studies have explored UU outcomes in individuals with long-term SCI, therefore we conducted this study with the following aims:…”