Bladder management methods and urological complications in spinal cord injury patients

This study investigated the satisfaction with continued detrusor Botox injections for urinary incontinence and conversion to other surgical procedures and bladder management procedures for neurogenic detrusor overactivity (NDO) in patients with chronic spinal cord injury (SCI). A total of 223 patients with chronic SCI underwent detrusor Botox 200U for urodynamically confirmed NDO and urinary incontinence. After initial detrusor Botox injections, patients opted to either continue detrusor Botox injections every six to nine months and on clean intermittent catheterization (CIC), switch to other bladder management procedures, or receive surgical procedures to improve their urinary incontinence, correct emergent complications, or have better voiding conditions without CIC. Urinary incontinence improvement rates and satisfaction with bladder management were assessed and compared between different subgroups, urodynamic parameters, and bladder management procedures. Finally, a total of 154 male and 69 female patients were included, among whom 56 (25.1%), 81 (36.3%), 51 (22.9%), and 35 (15.7%) showed a marked, moderate, mild, and no reduction in urinary incontinence, respectively. However, only 48.4% of the patients continued detrusor Botox injections over the mean follow-up period of seven years. Patients with cervical or thoracic SCI had fair incontinence improvement rates. The presence of high detrusor pressure and higher-grade bladder outlet resistance also predicted a decrease in incontinence. Although more than 50% of the patients switched to other bladder management procedures or received surgical treatment, 69.1% expressed satisfaction with their current status. This large cohort of patients with chronic SCI who received initial detrusor Botox injections revealed that only 48.4% continued with Botox injections. Those who received surgical procedures due to urological complications or demanded change in bladder management could achieve high satisfaction rates.

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Long term Urological complications in patients with Spinal cord injury

Medical Journal of Shree Birendra Hospital ◽

10.3126/mjsbh.v17i2.17732 ◽

2018 ◽

Vol 17 (2) ◽

pp. 38

Author(s):

Bikash Bikram Thapa ◽

Dhan Bahadur Shrestha ◽

Naryan Thapa ◽

Bharat Bahadur Bhandari

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Urinary Tract Infection ◽

Urinary Tract ◽

Urinary Bladder ◽

Tract Infection ◽

Urological Complications ◽

Cord Injury ◽

Bladder Management ◽

Urinary Bladder Calculi

Introduction: Neurogenic bladder (NGB) is common in daily urological practice; however, information on types of urological complications encountered in army and veterans are not under strict surveillance and little is known to them about the best way to manage the condition. This observational study aimed to determine the types of urological complications encountered in regular soldiers and veterans with traumatic spinal cord injury (SCI) with NGB, and the usage of bladder management programs to deal with NGB.Methods: We retrospectively reviewed the charts and records of interviewed patients with SCI in our urology clinic. Demographic data collected included: age, gender, mode of injury and level of spinal injury. Also noted were episodes of urinary tract infection (UTI), renal lesions, and bladder program followed.Results: The mean age of our study sample (N= 63) was 40± 10.8 years and all were male. Age at onset of injury was 33.8 ± 16.6 years and duration since SCI insult was 90.6 ± 54 months. Symptomatic urinary tract infection (75%), chronic cystitis (53.3%), hydro-nephrosis (36.5%) and urinary bladder calculi (33.3%) were the common urological lesion observed. Indwelling Foley’s catheterization methods of urinary bladder management in 54% study population where urinary tract infection is more common (p<0.05).Conclusion: Urinary tract infection, hydro-nephrosis and Urinary bladder calculi were the most common urological complications encountered in army and veterans with NGB. Indwelling Foley’s catheter was the most frequently used bladder management program with the higher risk for UTI.Key words: Neurogenic bladder, Spinal cord injury, Urinary tract infection, Nepal, Army

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Long term Urological complications in patients with Spinal cord injury

Medical Journal of Shree Birendra Hospital ◽

10.3126/mjsbh.v17i1.17732 ◽

2018 ◽

Vol 17 (1) ◽

pp. 38-43

Author(s):

Bikash Bikram Thapa ◽

Dhan Bahadur Shrestha ◽

Naryan Thapa ◽

Bharat Bahadur Bhandari

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Urinary Tract Infection ◽

Urinary Tract ◽

Urinary Bladder ◽

Tract Infection ◽

Urological Complications ◽

Cord Injury ◽

Bladder Management ◽

Urinary Bladder Calculi

Introduction: Neurogenic bladder (NGB) is common in daily urological practice; however, information on types of urological complications encountered in army and veterans are not under strict surveillance and little is known to them about the best way to manage the condition. This observational study aimed to determine the types of urological complications encountered in regular soldiers and veterans with traumatic spinal cord injury (SCI) with NGB, and the usage of bladder management programs to deal with NGB.Methods: We retrospectively reviewed the charts and records of interviewed patients with SCI in our urology clinic. Demographic data collected included: age, gender, mode of injury and level of spinal injury. Also noted were episodes of urinary tract infection (UTI), renal lesions, and bladder program followed.Results: The mean age of our study sample (N= 63) was 40± 10.8 years and all were male. Age at onset of injury was 33.8 ± 16.6 years and duration since SCI insult was 90.6 ± 54 months. Symptomatic urinary tract infection (75%), chronic cystitis (53.3%), hydro-nephrosis (36.5%) and urinary bladder calculi (33.3%) were the common urological lesion observed. Indwelling Foley’s catheterization methods of urinary bladder management in 54% study population where urinary tract infection is more common (p<0.05).Conclusion: Urinary tract infection, hydro-nephrosis and Urinary bladder calculi were the most common urological complications encountered in army and veterans with NGB. Indwelling Foley’s catheter was the most frequently used bladder management program with the higher risk for UTI.

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