RESUMEN
STUDY DESIGN: Cross-sectional descriptive study. OBJECTIVES: To assess long-term effects and quality of life (QoL) of using sacral anterior root stimulation (SARS) in spinal cord injured patients. SETTING: Neurosurgical and Urological Departments of a large teaching hospital and a large rehabilitation centre in the Netherlands. METHODS: In all, 42 patients with complete spinal cord injury (SCI) implanted between 1987 and 2000 were included. A questionnaire was constructed to determine complications, technical failures and personal experiences of the patients. The Qualiveen questionnaire was used and the outcome was compared with data obtained from a reference group of 400 SCI patients with neurogenic bladder problems not using the bladder controller. The Qualiveen questionnaire measures disease-specific aspects in four domains with respect to limitations, constraints, fears and feelings and general QoL aspects, suitable for use in SCI patients with urinary disorders. RESULTS: The results of 37 patients are presented. Our results with the bladder controller with respect to medical and technical complications and infection rates are similar to the results presented by others. From users' experiences, the most important advantages reported were a decreased infection rate (68%), improved social life (54%) and continence (54%). Comparison of the obtained results of our patient group with the Qualiveen questionnaire with a reference group not using the bladder controller indicates that the specific impact of urinary disorders in the four domains on QoL is reduced and that general QoL is improved. CONCLUSION: SARS is effective and safe for neurogenic bladder management in patients with complete SCI. Users' experiences are positive. Furthermore, this therapy seems to reduce the effects of urinary-disorder-specific QoL aspects, and to increase the QoL in general.
Asunto(s)
Terapia por Estimulación Eléctrica/métodos , Calidad de Vida , Traumatismos de la Médula Espinal/complicaciones , Raíces Nerviosas Espinales , Vejiga Urinaria Neurogénica/etiología , Vejiga Urinaria Neurogénica/terapia , Adulto , Estudios Transversales , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Países Bajos , Sacro , Encuestas y Cuestionarios , Resultado del TratamientoAsunto(s)
Enfermedades de la Aorta/inmunología , Arteriosclerosis Obliterante/inmunología , Enfermedades Autoinmunes/etiología , Fibrosis Retroperitoneal/etiología , Aorta Abdominal , Aneurisma de la Aorta/complicaciones , Autoanticuerpos , Humanos , Masculino , Persona de Mediana Edad , Fibrosis Retroperitoneal/inmunología , Fibrosis Retroperitoneal/patologíaRESUMEN
The true incidence of posterior urethral valves is unknown. They may cause major or minor urinary tract malfunction, reflecting the broad spectrum of degree of congenital malformation. Of 124 boys with posterior urethral valves 76 per cent had only minor secondary abnormalities and 24 per cent had secondary problems, such as large paraureteral diverticula, high grade reflux with upper tract damage, megaureter, hydronephrosis and uremia. The diagnosis of posterior urethral valves was based on voiding cystourethrography and endoscopy. Only types I and III values were found in our study. Except for 1 case, the valves were fulgurated endoscopically. Upper tract drainage was necessary in only 4 cases and kidney transplantation was required in 1. Most patients were cured by valve fulguration. Reflux disappeared in more than 50 per cent. Urodynamic studies in 16 patients with persistent complaints of diurnal and nocturnal enuresis revealed further bladder dysfunction.