Vesicoureteral reflux and bladder management in spinal cord injury patients

Vaidyanathan, S; Singh, G.; Soni, B M; Hughes, Peter L; Parsons, K. F.; Sett, P

doi:10.1038/sj.sc.3101266

Cited by 6 publications

(3 citation statements)

References 3 publications

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“…Indeed, Yavuzer et al reported a patient whose VUR was treated with an indwelling catheter and oxybutynin. 27 In the present study, all 3 patients who recovered from VUR had an increased bladder volume and compliance. As spontaneous recovery can occur, 26 the effectiveness of anticholinergics on VUR should be further examined.…”

Section: Discussionsupporting

confidence: 49%

Effect of imidafenacin on the urodynamic parameters of patients with indwelling bladder catheters due to spinal cord injury

et al. 2016

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Study design:A retrospective study.Objectives:To investigate the effect of imidafenacin on the urodynamic parameters of patients with indwelling bladder catheters due to spinal cord injury (SCI).Setting:Spinal center (Tokyo, Japan).Methods:Imidafenacin was prescribed to 34 patients with SCI who had a low cystometric volume and/or detrusor compliance according to a urodynamic study. A low cystometric volume and detrusor compliance were defined as <200 ml and <20 ml cm−1 H2O, respectively. The urodynamic study was repeated 4 weeks after imidafenacin was prescribed. When the urodynamic parameters did not improve in the follow-up study, the dose of imidafenacin was increased twofold. Then the urodynamic study was repeated 4 weeks thereafter. We compared the urodynamic parameters before and after imidafenacin treatment. Complications such as vesico-urethral reflux (VUR) and autonomic dysreflexia (AD) were documented.Results:Fifteen patients took 0.2 mg of imidafenacin daily, and 19 received 0.4 mg of imidafenacin daily. Imidafenacin increased the cystometric volume from 246.0 to 321.5 ml (median, P=0.002), detrusor compliance from 6.67 ml cm−1 H2O to 8.98 ml cm−1 H2O (median, P=0.012), and decreased the detrusor pressure from 37.0 cm H2O to 30.5 cm H2O (median, P=0.056). All three patients who had VUR fully recovered. Although 3 of 12 patients recovered from AD, 3 patients newly developed symptoms of AD. No patient withdrew from treatment due to adverse effects.Conclusion:Imidafenacin is a safe drug that may improve the urodynamic parameters of patients with SCI, and it possibly alleviates bladder complications.

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Section: Discussionsupporting

confidence: 49%

Effect of imidafenacin on the urodynamic parameters of patients with indwelling bladder catheters due to spinal cord injury

et al. 2016

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“…Alternatively, detection of early squamous metaplasia in a patient using penile sheath draining may suggest to the physician that incomplete bladder emptying is causing recurrent urinary tract infections, prompting a need for supplementary catheterisations. 5 Intermittent catheterisation should ideally be combined with anticholinergic agents such as oxybutynin to achieve complete, low pressure, bladder emptying.…”

Section: Discussionmentioning

confidence: 99%

Detection of early squamous metaplasia in bladder biopsies of spinal cord injury patients by immunostaining for cytokeratin 14

et al. 2003

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Study design: A prospective, immunohistochemical study of bladder biopsies taken from spinal cord injury (SCI) patients. Objectives: To investigate whether cytokeratin 14 immunostaining may be useful to detect early squamous metaplasia in bladder biopsies from patients with SCI. Setting: Southport, United Kingdom. Methods: Biopsy of bladder mucosa was taken from adults with SCI, while they underwent an elective therapeutic procedure in the urinary tract. A total of, 54 biopsies, which showed transitional epithelium only with no evidence of squamous metaplasia on routine H&E staining, formed the study group. In all, 22 biopsies, which showed squamous metaplasia on routine H&E staining, acted as controls. All biopsies were benign with no evidence of dysplasia or malignancy. Immunohistochemical staining for cytokeratin 14 was performed on all biopsies in a single batch, using a standard avidin-biotin complex method. Results: All control biopsies showed positive immunostaining for cytokeratin 14 in basal and parabasal cells in areas of squamous metaplasia. Of the 54 biopsies, which showed only transitional epithelium on H&E staining, immunohistochemistry for cytokeratin 14 showed no staining in 47 biopsies. The remaining seven biopsies showed positive immunostaining for cytokeratin 14 in the epithelium, in individual cells or clusters of basal cells, revealing unexpected early squamous metaplasia in these biopsies. Conclusion: Immunostaining for cytokeratin 14 identifies an early phenotypic switch from transitional to squamous epithelium in bladder mucosa. Cytokeratin 14 staining is sufficiently sensitive to identify early squamous metaplasia, which is not yet evident on examination of routine H&E stained sections. This early identification may be of use in alerting physicians to change bladder management regimens to prevent predisposition to recurrent urinary infection and progression of squamous metaplasia. A cost/benefit analysis should be performed to assess the feasibility of routine cytokeratin 14 immunostaining of bladder biopsies from SCI patients.

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“…While reviewing our clinical practice [13], we realised that we had failed to prescribe angiotensin-converting enzyme inhibitor or angiotensin receptor blocking agent to some patients with reflux nephropathy and proteinuria. In a 69-year-old male with T-12 paraplegia, videourodynamics showed bilateral grade 3 vesicoureteral reflux and hyperreflexic contraction with detrusor pressures exceeding 100 cm of water.…”

Section: Discussionmentioning

confidence: 99%

Fatal Renal Failure in a Spinal Cord Injury Patient with Vesicoureteric Reflux Who Underwent Repeated Ureteric Reimplantations Unsuccessfully: Treatment Should Focus on Abolition of High Intravesical Pressures rather than Surgical Correction of Reflux

Vaidyanathan

Soni²,

Abraham³

et al. 2012

Case Reports in Urology

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A 29-year-old man developed paraplegia at T-10 level due to road traffic accident in 1972. Both kidneys were normal and showed good function on intravenous urography. Division of external urethral sphincter was performed in 1973. In 1974, cystogram showed retrograde filling of left renal tract, which was hydronephrotic. Left ureteric reimplantation was performed. Following surgery, cystogram revealed marked retrograde filling of left renal tract as before. Penile sheath drainage was continued. In 1981, intravenous urography revealed bilateral severe hydronephrosis. Left ureteric reimplantation was performed again in 1983. Blood pressure was 220/140 mm Hg; this patient was prescribed atenolol. Cystogram showed gross left vesicoureteral reflux. Intermittent catheterisation was commenced in 2001. In 2007, proteinuria was 860 mg/day. This patient developed progressive renal failure and expired in 2012. In a spinal cord injury patient with vesicoureteral reflux, the treatment should focus on abolition of high intravesical pressures rather than surgical correction of vesicoureteric reflux. Detrusor hyperactivity and high intravesical pressures are the basic causes for vesicoureteral reflux in spinal cord injury patients. Therefore, it is important to manage spinal cord injury patients with neuropathic bladder by intermittent catheterisations along with antimuscarinic drug therapy in order to abolish high detrusor pressures and prevent vesicoureteral reflux. Angiotensin-converting enzyme inhibitors or angiotensin-receptor-blocking agents should be prescribed even in the absence of hypertension when a spinal cord injury patient develops vesicoureteral reflux and proteinuria.

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Vesicoureteral reflux and bladder management in spinal cord injury patients

Cited by 6 publications

References 3 publications

Effect of imidafenacin on the urodynamic parameters of patients with indwelling bladder catheters due to spinal cord injury

Effect of imidafenacin on the urodynamic parameters of patients with indwelling bladder catheters due to spinal cord injury

Detection of early squamous metaplasia in bladder biopsies of spinal cord injury patients by immunostaining for cytokeratin 14

Fatal Renal Failure in a Spinal Cord Injury Patient with Vesicoureteric Reflux Who Underwent Repeated Ureteric Reimplantations Unsuccessfully: Treatment Should Focus on Abolition of High Intravesical Pressures rather than Surgical Correction of Reflux

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