Urologic status of 74 spinal cord injury patients from the 1976 Tangshan earthquake, and managed for over 20 years using the Credé maneuver

Transcriptomics Reveals Molecular Features of the Bilateral Pelvic Nerve Injury Rat Model of Detrusor Underactivity

The pathogenesis of detrusor underactivity (DU) is unclear, and the available therapeutic effects are unsatisfactory. We propose to find key molecules and pathways related to DU based on transcriptome sequencing. A rat model of bilateral pelvic nerve injury (BPNI) was established. Bladder tissues from the sham-operated group, 3 and 28 days after BPNI mapping, were taken for urodynamics, histopathology, and RNA-seq. An enrichment analysis of the screened differential expression genes was performed. Three days after BPNI, the results showed urodynamic features of overflow incontinence, while there was a recovery at 28 days after the operation. Masson staining revealed collagen deposition accompanied by progressive thickening of the smooth muscle layer as DU progressed. RNA-seq results suggested that a total of 1808 differentially expressed genes (DEGs) differed among the groups. RNA-seq and subsequent analysis confirmed that the cell cycle and immune response were significantly activated 3 days after BPNI, while extracellular matrix remodeling occurred 28 days after BPNI. Partial DEGs and pathways were verified by qRT-PCR. Validation of key proteins involved in cell cycle, inflammation, and fibrosis was performed by immunohistochemical staining and western blot, respectively. These molecular expression patterns at different time points after BPNI injury provide valuable insights into the search for therapeutic targets for DU.

A nonsurgical and nonpharmacological care bundle for preventing upper urinary tract damage in patients with spinal cord injury and neurogenic bladder

AIM

To establish a care bundle in spinal cord injury patients with neurogenic bladder to avoid upper urinary tract damage and to provide guidance for health care staff in use of nonsurgical and nonpharmacological adjunctive strategies to improve patients' clinical outcomes.

BACKGROUND

Prevention of upper urinary tract damage is critical in the management of spinal cord injury patients with a neurogenic bladder, but there are no authoritative guidelines or high-quality randomized controlled trials.

DESIGN

The study was conducted on the basis of Fulbrook and Mooney's seven-step method for care bundle development.

DATA SOURCES

The databases PubMed, Embase, Science Citation Index, the Cumulative Index to Nursing and Allied Health Literature, the National Guideline Clearinghouse, the Cochrane Library, China Biology Medicine, China National Knowledge Infrastructure, and China Dissertation Database were searched from the date of each database's inception to April 2017.

REVIEW METHODS

We evaluated the literature according to the Joanna Briggs Institute evidence pre-ranking and grade recommendation system (2014 version). The results were examined using a self-designed data extraction.

RESULTS

A three-element cluster including clean intermittent catheterization, bladder function training, and transcutaneous low-frequency pulsed electrical stimulation was formed.

CONCLUSION

The development of this bundle can provide a scientific basis for effective prevention of neurogenic upper urinary tract damage in clinical practice.

Urinary tract infections in patients with neurogenic bladder

Urinary tract infections (UTIs) in patients with neurogenic bladder are a major public health issue due to their high incidence and major consequences. Despite their frequency and potential severity, their physiopathology and management are poorly known. We provide a narrative literature review on the epidemiology, physiopathology, diagnostic criteria, microbiology, antimicrobial management, and prevention. UTIs among patients with neurogenic bladder are associated with high morbidity and healthcare utilization. Risk factors for UTI among this population are: indwelling catheter, urinary stasis, high bladder pressure, and bladder stones. Their diagnosis is a major challenge as clinical signs are often non-specific and rare. A urinary sample should be analyzed in appropriate conditions before any antibiotic prescription. According to most guidelines, a bacterial threshold≥103CFU/ml associated with symptoms is acceptable to define UTI in patients with neurogenic bladder. The management of acute symptomatic UTI is not evidence-based. A management with a single agent and a short antibiotic treatment of 10 days or less seems effective. Antibiotic selection should be based on the patient's resistance patterns. Asymptomatic bacteriuria should not be treated to avoid the emergence of bacterial resistance. Regarding preventive measures, use of clean intermittent catheterization, intravesical botulinum toxin injection, and prevention using antibiotic cycling are effective. Bacterial interference is promising but randomized controlled trials are needed. Large ongoing cohorts and randomized controlled trials should soon provide more evidence-based data.

Current and future international patterns of care of neurogenic bladder after spinal cord injury

PURPOSE

We aim to summarize the literature on international patterns of care for patients with neurogenic bladder (NGB) from spinal cord injury (SCI).

METHODS

We performed a PubMed database search, hand review of references, communication with professional societies, and registry evaluations for pertinent data.

RESULTS

Established patterns of care, including SCI registries and specialty centers, are available in high-resource countries such as the US and UK. As such, mortality rates from complications of NGB/SCI are lower. Access to intermittent catheterization supplies, among other resources, may be inadequate in many low-income regions. Cultural and religious beliefs may also hinder integration of proper bladder management in SCI patients. While guidelines exist in many parts of the world, it is unclear how rigorously they are disseminated or followed.

CONCLUSIONS

While there is a paucity of high-level evidence, the differences in patterns of care are closely related to socioeconomic status and resources of the geographic area. Future research efforts should focus on improving access to diagnostic modalities, supplies, and specialists in these areas.

Alarming blood pressure changes during routine bladder emptying in a woman with cervical spinal cord injury

INTRODUCTION

Many individuals with high-level spinal cord injury (SCI) experience secondary conditions such as autonomic dysreflexia (AD), which is a potentially life-threatening condition comprising transient episodes of hypertension up to 300 mmHg. AD may be accompanied by symptoms and signs such as headache, flushing, and sweating. Delay in AD recognition and management is associated with increased incidence of cardiovascular events and disease. As it is commonly triggered by bladder distension, AD continues to be a major concern for individuals living with SCI, both on a daily basis and in the long-term.

CASE PRESENTATION

A 58-year-old woman with C3 AIS B SCI presented with low resting blood pressure (BP) at 100/64 mmHg. She reported frequent episodes of AD that were most commonly attributed to urinary bladder filling. During our testing session, her systolic BP rose to 130 mmHg, at which point her care aide stepped in to utilize the Credé maneuver, which was part of her daily routine for bladder emptying. Application of suprapubic pressure further elevated her systolic BP to 230 mmHg. Throughout the episode of AD, the participant experienced a pounding headache and erythema above the LOI.

DISCUSSION

Clinical guidelines for bladder management after SCI recommend avoiding the Credé maneuver due to potential complications such as hernia or bruising. This current case report demonstrates the additional risk of inducing AD and dangerously high BP elevation.

What do we know about neurogenic bladder prevalence and management in developing countries and emerging regions of the world?

OBJECTIVE

To summarize information on Neurogenic Bladder (NB) epidemiology, management and access to patient treatment in developing countries and emerging regions of the world in order to propose future interventions and help governmental as well as non-governmental organizations design their action plans.

METHODS

Different search methods were used to gather the maximum available data. They included strategic searches; reference checks; grey literature searches (reports, working papers, government documents, civil society information); contacting professional societies, registries, and authors; requesting unpublished data from organizations; and browsing related websites and journals.

RESULTS

The incidence and prevalence rates of NB in developing countries are difficult to establish because epidemiological reports are few and far between. The frequency of bladder dysfunction in neurologically impaired populations can be approximately estimated in some of these countries. Similar information paucity affects diagnostic and therapeutic approaches to NB patients living in less-developed regions of the world. The assessment and management of NB seems to vary markedly between countries, and care of patients from emerging regions of the world is often inadequate.

CONCLUSION

Strong concerted efforts are needed on the part of international scientific societies, non-governmental organizations and local governments to work together to change the prognosis for these patients and to improve their quality of life.

Management of neurogenic lower urinary tract dysfunction in multiple sclerosis patients

Multiple sclerosis (MS) can be a debilitating neurological condition that attributes significant morbidity to bladder dysfunction. Although many effective treatment options exist, symptomatic patients are often underdiagnosed and undertreated. The purpose of this article is to give an overview of the current literature including new screening tools to identify symptomatic patients and updates on treatment options including medications, botulinum toxin, and neuromodulation.

Neurogenic bladder in spinal cord injury patients

Neurogenic bladder dysfunction due to spinal cord injury poses a significant threat to the well-being of patients. Incontinence, renal impairment, urinary tract infection, stones, and poor quality of life are some complications of this condition. The majority of patients will require management to ensure low pressure reservoir function of the bladder, complete emptying, and dryness. Management typically begins with anticholinergic medications and clean intermittent catheterization. Patients who fail this treatment because of inefficacy or intolerability are candidates for a spectrum of more invasive procedures. Endoscopic managements to relieve the bladder outlet resistance include sphincterotomy, botulinum toxin injection, and stent insertion. In contrast, patients with incompetent sphincters are candidates for transobturator tape insertion, sling surgery, or artificial sphincter implantation. Coordinated bladder emptying is possible with neuromodulation in selected patients. Bladder augmentation, usually with an intestinal segment, and urinary diversion are the last resort. Tissue engineering is promising in experimental settings; however, its role in clinical bladder management is still evolving. In this review, we summarize the current literature pertaining to the pathology and management of neurogenic bladder dysfunction in patients with spinal cord injury.

Dysfunction of lower urinary tract in patients with spinal cord injury

Over the past 50 years, the mortality for urorenal cause in patients with spinal cord injuries (SCI) has decreased from over 75% to 2.3%, as a result of dramatic improvements in the diagnosis and management of lower urinary tract dysfunction (LUTD). The aims of this chapter are to assess the physiopathology of upper and lower motor neuron lesion on bladder and sphincter function after SCI, to give an overview of required clinical and instrumental examination and to discuss treatment modalities. Videourodynamic examination plays a key role in the assessment and follow-up of LUTD in SCI patients, in conjunction with neurophysiological and radiological examinations. The cornerstone of bladder management in SCI is clean intermittent self-catheterization, but often other treatments are needed to achieve full continence, to reduce infections and stone formation, to protect the upper urinary tract from excessive bladder pressure, and to prevent chronic renal failure. Treatments may be pharmacologic (i.e., anticholinergic drugs and botulinum toxin) or surgical (by enterocystoplasty or urinary diversion). In selected cases, neuromodulation and sacral root stimulation can be used to reduce detrusor overactivity and empty the bladder. Management of LUTD in SCI patients requires a deep knowledge of spinal cord medicine and functioning of patients with neurologic disability.

Influence of different urination methods on the urinary systems of patients with spinal cord injury

OBJECTIVE

This study evaluated the influence of different urination methods on the urinary systems of patients with spinal cord injury.

METHODS

Patients with spinal cord injury were grouped according to their usual voiding method: clean intermittent catheterization (CIC); Credé manoeuvre/reflex voiding; indwelling catheterization; normal voiding. Urinary tract infections (UTIs) were monitored and type B-ultra-sonography (B-USG) scans, renal function tests and urodynamic studies were performed in all patients over a 2-year period.

RESULTS

Compared with the normal voiding group (n = 14), incidence rates of UTIs were significantly different in the Credé manoeuvre/reflex voiding (n = 26) and indwelling catheterization (n = 12) groups but not in the CIC group (n = 15). All intervention groups had a significantly higher rate of positive findings on B-USG scan and a significantly increased residual urine volume, compared with the normal voiding group. In addition, residual urine volume was significantly lower in the CIC group compared with the Credé manoeuvre/reflex voiding and indwelling catheterization groups.

CONCLUSION

CIC was shown to be the optimal method for assisted bladder voiding after spinal cord injury.

Bladder management of patients with spinal cord injuries sustained in the 2008 Wenchuan earthquake

This study's aim is provide an overview of the patients who suffered spinal cord injury (SCI) after the magnitude 8.0 Wenchuan earthquake, including each patient's demographic and epidemiological characteristics, bladder management status, and quality of life (QOL). We also assessed the relationships between bladder management methods, symptomatic urinary tract infection (SUTI), and QOL. Two years after the 2008 Wenchuan earthquake, a cross-sectional face-to-face survey was conducted on 180 patients with SCI. A self-administered questionnaire and the WHOQOL-BREF assessment were used to assess injury-related information, bladder management methods, and SUTI. Statistical analysis was performed using the Chi-square test and analysis of variance. A p value <0.05 was considered statistically significant. This study found that a male-to-female ratio of approximately 1.2:1, including 98 (54.4%) male patients and 82 (45.6%) female patients. Thoracic-level injuries were seen in 82 patients (45.56%), 60 (33.33%) patients had lumbar-level injuries, 18 (8.33%) patients had thoracolumbar-level injuries, and a small number of patients had cervical- or sacral-level injuries. Sixty-two patients (34.44%) demonstrated normal voiding, 65 (36.11%) required manually assisted voiding, 29 (16.11%) required catheterization, and 24 (13.33%) used aurine-collecting apparatus. The prevalence of SUTI was 43.89%. Patients who emptied their bladder via manually assisted voiding, catheterization, or with the use of a urine-collecting apparatus demonstrated higher rates of SUTI compared with patients who voided normally (p < 0.05); the patients who required catheterization had higher rates of SUTI compared with patients who required manually assisted voiding (p < 0.05). When manually assisted voiding and catheterization were compared with the use a urine-collecting apparatus, no statistically significant differences were observed in terms of the risk of developing SUTI. The patients in this study demonstrated low scores on the WHOQOL-BREF physical domain (11.61 ± 3.80), psychological domain (10.11 ± 3.63), social domain (11.46 ± 2.84), and environmental domain (11.86 ± 2.51). The patients who reported normal voiding also demonstrated the best QOL in terms of physical, psychological, and social component scores (p < 0.05). In conclusion, the percentage of women in this study is higher than that reported in other studies on traumatic causes of SCI. Patients who suffered SCI following the Wenchuan earthquake demonstrate poor bladder management status and are unable to take advantage of urodynamic testing that is used to monitor the functional state of the bladder. This study's findings indicate that bladder management methods influence the rate of SUTI and the QOL of patients with SCI. Caring for SCI patients following a disaster requires comprehensive long-term planning. Bladder management of patients with SCI is essential for improving the QOL of these patients.

Bladder management methods and urological complications in spinal cord injury patients

BACKGROUND

The optimal bladder management method should preserve renal function and minimize the risk of urinary tract complications. The present study is conducted to assess the overall incidence of urinary tract infections (UTI) and other urological complications in spinal cord injury patients (SCI), and to compare the incidence of these complications with different bladder management subgroups.

MATERIALS AND METHODS

545 patients (386 males and 159 females) of traumatic spinal cord injury with the mean age of 35.4±16.2 years (range, 18 - 73 years) were included in the study. The data regarding demography, bladder type, method of bladder management, and urological complications, were recorded. Bladder management methods included indwelling catheterization in 224 cases, clean intermittent catheterization (CIC) in 180 cases, condom drainage in 45 cases, suprapubic cystostomy in 24 cases, reflex voiding in 32 cases, and normal voiding in 40 cases. We assessed the incidence of UTI and bacteriuria as the number of episodes per hundred person-days, and other urological complications as percentages.

RESULTS

The overall incidence of bacteriuria was 1.70 / hundred person-days. The overall incidenceof urinary tract infection was 0.64 / hundered person-days. The incidence of UTI per 100 person-days was 2.68 for indwelling catheterization, 0.34 for CIC, 0.34 for condom drainage, 0.56 for suprapubic cystostomy, 0.34 for reflex voiding, and 0.32 for normal voiding. Other urological complications recorded were urethral stricture (n=66, 12.1%), urethritis (n=78, 14.3%), periurethral abscess (n=45, 8.2%), epididymorchitis (n=44, 8.07%), urethral false passage (n=22, 4.03%), urethral fistula (n=11, 2%), lithiasis (n=23, 4.2%), hematuria (n=44, 8.07%), stress incontinence (n=60, 11%), and pyelonephritis (n=6, 1.1%). Clean intermittent catheterization was associated with lower incidence of urological complications, in comparison to indwelling catheterization.

CONCLUSIONS

Urinary tract complications largely appeared to be confined to the lower urinary tract. The incidence of UTI and other urological complications is lower in patients on CIC in comparison to the patients on indwelling catheterizations. Encouraging CIC; early recognition and treatment of the UTI and urological complications; and a regular follow up is necessary to reduce the medical morbidity.

Bladder management methods and urological complications in spinal cord injury patients

BACKGROUND

The optimal bladder management method should preserve renal function and minimize the risk of urinary tract complications. The present study is conducted to assess the overall incidence of urinary tract infections (UTI) and other urological complications in spinal cord injury patients (SCI), and to compare the incidence of these complications with different bladder management subgroups.

MATERIALS AND METHODS

545 patients (386 males and 159 females) of traumatic spinal cord injury with the mean age of 35.4±16.2 years (range, 18 - 73 years) were included in the study. The data regarding demography, bladder type, method of bladder management, and urological complications, were recorded. Bladder management methods included indwelling catheterization in 224 cases, clean intermittent catheterization (CIC) in 180 cases, condom drainage in 45 cases, suprapubic cystostomy in 24 cases, reflex voiding in 32 cases, and normal voiding in 40 cases. We assessed the incidence of UTI and bacteriuria as the number of episodes per hundred person-days, and other urological complications as percentages.

RESULTS

The overall incidence of bacteriuria was 1.70 / hundred person-days. The overall incidenceof urinary tract infection was 0.64 / hundered person-days. The incidence of UTI per 100 person-days was 2.68 for indwelling catheterization, 0.34 for CIC, 0.34 for condom drainage, 0.56 for suprapubic cystostomy, 0.34 for reflex voiding, and 0.32 for normal voiding. Other urological complications recorded were urethral stricture (n=66, 12.1%), urethritis (n=78, 14.3%), periurethral abscess (n=45, 8.2%), epididymorchitis (n=44, 8.07%), urethral false passage (n=22, 4.03%), urethral fistula (n=11, 2%), lithiasis (n=23, 4.2%), hematuria (n=44, 8.07%), stress incontinence (n=60, 11%), and pyelonephritis (n=6, 1.1%). Clean intermittent catheterization was associated with lower incidence of urological complications, in comparison to indwelling catheterization.

CONCLUSIONS

Urinary tract complications largely appeared to be confined to the lower urinary tract. The incidence of UTI and other urological complications is lower in patients on CIC in comparison to the patients on indwelling catheterizations. Encouraging CIC; early recognition and treatment of the UTI and urological complications; and a regular follow up is necessary to reduce the medical morbidity.

Statewide investigation of medically attended adverse health conditions of persons with spinal cord injury

BACKGROUND/OBJECTIVE

To report over a 10-year period the statewide prevalence and incidence of medically attended adverse health conditions in people with new traumatic spinal cord injury (TSCI).

DESIGN

Retrospective cohort study.

METHODS

(a) Identified all new TSCI cases discharged alive from statewide acute care hospitals, 1996 to 2000, using ICD-9-CM methodology. (b) Followed cases from 1996 to 2005 to quantify medically attended health conditions documented during emergency department visits, acute care hospitalizations, and outpatient hospital visits. (c) Used the life table method to calculate the prevalence and incidence of health conditions. (d) Examined Cox proportional hazard ratio of mortality by gender controlling for age and TSCI severity.

RESULTS

Nine hundred eighty-eight residents (257 women, 731 men) with TSCI were alive 90 days after discharge from acute care hospitalization from 1996 to 2000. Nine hundred twenty-three (251 female, 672 male) (93.4%) residents had an observed medically attended adverse health condition in the 10-year followup period. The most prevalent classes of diseases and disorders were (a) muscle and connective tissue, (b) renal and urinary, (c) digestive, (d) circulatory, (e) respiratory, (f) endocrine/nutritional/metabolic, and (g) infectious. Incidence of new injury was 29.0% for males and 26.9% for females. During the follow-up period, 49 women (19%) and 104 men (14%) died.

CONCLUSIONS

People with TSCI experience diverse adverse health conditions in the 10 years after initial injury. An interdisciplinary health care provider team approach to allocating resources and implementing countermeasures to prevent or limit occurrence of these conditions is vital to these patient's continuum of care.

Chapitre A - Lithiase et vessie neurogène

Stones of the upper and lower urinary tract are frequently observed in spinal cord injury patients. In this article, the authors reviewed the literature to identify the most reliable tools for diagnosis and follow-up. A review of recently published series demonstrated an excess risk of kidney and bladder stones in this population. The authors discuss the possible measures of prevention and identification of high-risk groups likely to benefit from more intensive follow-up.

Chapitre B - Insuffisance rénale et vessie neurologique

Historically, impaired renal function was the leading cause of death in spinal cord injury patients. Although the management of these patients has considerably improved due to progress in functional rehabilitation and neurourology, renal failure remains a significant cause of morbidity in this population. In this article, the authors review and classify the diagnostic tools able to detect urological changes likely to induce irreversible impairment of renal function. Based on a review of the recent literature, they define the incidence of renal impairment (morphological or function) in spinal cord injury patients and describe the main risk factors for deterioration of renal function in these patients.

Aging, gender, and spinal cord injury

OBJECTIVE

To identify differences in the aging experiences of men and women with spinal cord injury (SCI).

DESIGN

This study is part of a longitudinal international study of aging and SCI.

SETTING

Five centers in England, Canada, and the United States. Three were spinal cord rehabilitation facilities (Stoke-Mandeville Hospital, Southport Hospital, Craig Hospital) and 2 were community agencies (Ontario and Manitoba divisions of the Canadian Paraplegic Association).

PARTICIPANTS

A matched sample of 67 men and 67 women with SCI for at least 20 years. The 2 groups were matched on age, country of origin, and duration of disability. Participants had an average age of 57 years and an average disability duration of almost 33 years.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Two measures were taken by interview: demographic form and current status interview. Five others were self-administered and returned by mail: the Perceived Stress Scale, Craig Handicap Assessment and Reporting Technique, Index of Psychological Well-Being, Current Problem Questionnaire, and Life Satisfaction Index.

RESULTS

Although both sexes rated their quality of life about equally, women characterized their aging experience as "accelerated," while men characterized it as "complicated." Women reported more effects of pain, fatigue, and skin problems and more transportation problems. Men experienced more health problems, more diabetes, and more adaptive equipment changes. Older men and women with SCI spent their time differently, consistent with traditional gender roles.

CONCLUSIONS

These results underline the need for gender-specific consideration of aging experiences associated with SCI and further emphasize the need for primary and preventive care to promote health and well-being as people with SCI survive into old age.

Pathogenesis of bacteriuria and infection in the spinal cord injured patient

Spinal cord injury (SCI) produces profound alterations in lower urinary tract function. Incontinence, elevated intravesical pressure, reflux, stones, and neurological obstruction, commonly found in the spinal cord-injured population, increase the risk of urinary infection. The overall rate of urinary infection in SCI patient is about 2.5 episodes per patient per year. Despite improved methods of treatment, urinary tract morbidity still ranks as the second leading cause of death in the SCI patient.SCI removes the ability of the pontine micturition center and higher centers in the brain to inhibit, control, or coordinate the activity of the vesicourethral unit. As a result, a patient with complete quadriplegia is typically unaware of bladder activity. Bladder contraction is accompanied by vesicosphincter dyssynergia instead of sphincter relaxation. It is widely accepted that intermittent catheterization, when compared with indwelling catheters, reduces the risk of urinary tract infection (UTI) in SCI patients and is the preferred method of bladder drainage in this patient population. Attempts at eliminating bacteriuria associated with indwelling or intermittent catheters have generally been unsuccessful. There is now appreciation of the fact that a creeping adherent biofilm of bacteria frequently ascends through the luminal and external surfaces of an indwelling catheter, often within 8 to 24 hours, leading to bacterial adherence to the bladder surface and correlating with symptomatic infection. The use of antimicrobial agents to clear or prevent bacteriuria in patients on indwelling or intermittent catheterization has had mixed success. Treatment for asymptomatic bacteriuria in SCI patients remains controversial. SCI patients with symptomatic urinary infections should be treated with the most specific, narrowest spectrum antibiotics available for the shortest possible time. Guidelines for selecting antimicrobial agents in SCI patients are similar to guidelines for the treatment of complicated urinary infections in the general population. Characteristics of the quinolones make them well suited to treating UTI in the SCI patient.

Urinary tract infection in individuals with spinal cord lesion

Urinary tract infection is the most frequently reported secondary impairment in individuals with spinal cord lesion. The most prevalent risk indicator is an indwelling catheter. Hydrophilic catheters for clean intermittent catheterization may induce lower rates of bacteriuria and long-term urethral complications. Due to chronic bacterial infection within biofilms, an antibacterial treatment based on a urinary culture of bacteria in the urine and its antimicrobial susceptibility may fail to eradicate catheter-associated urinary tract infection. No commercially available drugs are sufficiently active against the bacteria in a mature biofilm. Biomaterials may be modified to decrease the formation of a biofilm. Silver alloy catheters are effective in preventing urinary tract infection when indwelling urinary catheterization is necessary. The risk of systemic argyria in long-term use needs to be evaluated. Suprapubic cystostomy drainage in patients with neurogenic bladder is preferred to an indwelling urethral catheter. In cases of recurring urinary tract infection in patients with a permanent urinary catheter, it may be beneficial to change the catheter every 1 or 2 weeks. There is some evidence that cranberry products may prevent urinary tract infection. In the future, bacterial interference and vaccination may be a possibility for prevention of urinary tract infection.

Augmentation ileocystoplasty in patients with neurogenic bladder due to spinal cord injury or spina bifida

STUDY DESIGN

Retrospective analysis of augmentation ileocystoplasty for neurogenic bladder.

OBJECTIVES

To analyze the effects and complications of augmentation ileocystoplasty in patients with neurogenic bladder due to spinal cord injury (SCI) or spina bifida retrospectively.

SETTING

Department of Urology, Kanagawa Rehabilitation Hospital, Japan.

METHODS

We have treated 11 patients with neurogenic bladder due to SCI and 10 patients with spinal bifida with augmentation ileocystoplasty since 1989. The purpose of the treatment was to stop vesicoureteral reflux (VUR) and/or amelioration of urinary incontinence. In 17 of 21 cases, the antireflux operation was received simultaneously. All cases performed clean intermittent self catheterization postoperatively.

RESULTS

Urinary incontinence improved in all cases and only transient recurrence of VUR was observed in the follow-up term. Complications occurred in patients with SCI, but they could be treated conservatively.

CONCLUSION

Augmentation ileocystoplasty is a good treatment option for contracted bladder or VUR, which occurs in patients with neurogenic bladder.