Self-catheterization acquisition after hand reanimation protocols in C5–C7 tetraplegic patients

Abstract

Study design: Case series from a prospectively acquired database and phone survey. Objectives: To assess the efficacy of upper limb reanimation (ULR) protocols on acquisition of intermittent self-catheterization (ISC) in C5-C7 ASIA tetraplegic patients. Setting: University Hospital, Paris, France. Methods: A prospectively acquired database of 152 tetraplegic patients followed in ULR consultation between 1997 and 2008 in a rehabilitation unit was studied. A total of 20 patients met the inclusion criteria, which mainly were traumatic C5-C7 tetraplegic adult patients who were unable to perform ISC, and who benefited from ULR with the objectives of improving hand abilities and of ISC acquisition, through urethral orifice for males or via a continent urinary stoma for females. The main outcome measure was ISC acquisition (ISC þ ) proportion. Population characteristics and secondary outcome measures: ISC þ /ISCÀ patients were compared regarding epidemiological and surgical data, key-grip strength, patient global improvement score, activities of daily living and quality of life (PGI-I, Wuolle questionnaire, verbal rating scale). Results: ISC þ was 75%. It depended on key-grip strength (Po0.05) and led to a statistically significant improvement of urinary status compared with ISCÀ patients (Po0.01). ULR improved patients' abilities and QoL in both ISC þ and ISCÀ patients. Conclusion: ULR protocols allow ISC in most C5-C7 tetraplegic patients. Multidisciplinary care with surgeons and PRM physicians improves patients' vital and functional prognosis by changing their urological-management method.

Long‐term complications of continent cutaneous urinary diversion in adult spinal cord injured patients

“…These patients must be evaluated by a multidisciplinary team including a urologist and a rehab physician to assess their ability to reach a fake abdominal stoma and to perform subsequent ISC . If necessary, some patients can undergo prior surgery for upper‐limb reanimation, especially tetraplegic patients (upper C8). The optimal site for the stoma is patient specific.…”

Continent catheterizable tubes/stomas in adult neuro-urological patients: A systematic review

“…Therefore the creation of a CCS/T by enabling intermittent self‐catheterization is likely to reduce the well‐described high urinary complications rate of indwelling catheters in adult neuro‐urological patients . In the most complex situation, a surgical reanimation program of hand function could even improve tetraplegic patient eligibility for a CSS/T as mentioned in 1 out of 11 studies …”

Résultats à moyen terme du traitement de la dyssynergie vésicosphinctérienne par sphinctérotomie prothétique permanente

“…Certains patients tétraplégiques sélectionnés peuvent retrouver l'accès à l'autosondage via une cystostomie cutanée avec agrandissement vésical, parfois au prix d'un programme de réhabilitation chirurgicale du membre supé-rieur [9,10].…”