RESUMEN
STUDY DESIGN: Analysis of answers to a new questionnaire. OBJECTIVE: To examine current practice patterns of physicians in the urological surveillance and management of spinal cord injury (SCI) patients in Japan. SETTING: Nationwide questionnaire survey to physicians in Japan. METHODS: A Japanese version of the 14-item questionnaire survey carried out in US was mailed to 770 members of the Japanese Neurogenic Bladder Society (JNBS). RESULTS: We received answers to our questionnaire from 333 (43.2%) members of JNBS. The responders were all urologists. For surveillance of the upper urinary tract (UUT), 239 (71.8%) respondents preferred abdominal ultrasound. Cystometry was performed routinely by 174 (52.3%) respondents for the evaluation of vesicourethral function. Cystoscopy was carried out in cases of hematuria (88.0%) and bladder stone (55.3%). Surveillance of the urinary tract was performed every year in 154 (46.2%). For detection of bladder cancer, which 119 (37.9%) respondents have experienced, 94.9% physicians perform cystoscopy, 76.3% urinary cytology, and 60.4% ultrasound. For initial treatment of detrusor-sphincter dyssynergia (DSD), 225 (69.2%) respondents chose alpha-blocker, and 94 (28.9%) chose clean intermittent catheterization (CIC) with/without anticholinergic agent(s). For initial treatment of overactive bladder, 245 (74.7%) chose anticholinergic agent(s) only and 63 (19.2%) chose anticholinergic agent(s) with CIC. For initial treatment of areflexic bladder, 233 (73.7%) chose CIC and 63 (19.9%) chose Credé maneuver or tapping. CONCLUSIONS: This survey shows that there are some differences in urological surveillance and management of SCI patients between Japan and the US. Reasons for the discrepancy should be examined.
Asunto(s)
Vigilancia de la Población/métodos , Pautas de la Práctica en Medicina/estadística & datos numéricos , Traumatismos de la Médula Espinal/diagnóstico , Traumatismos de la Médula Espinal/terapia , Enfermedades Urológicas/diagnóstico , Enfermedades Urológicas/terapia , Comorbilidad , Encuestas de Atención de la Salud , Incidencia , Japón/epidemiología , Traumatismos de la Médula Espinal/epidemiología , Encuestas y Cuestionarios , Enfermedades Urológicas/epidemiologíaRESUMEN
STUDY DESIGN: Clinical case report with comments by colleagues from Austria, Belgium, Germany, Japan, and Poland. OBJECTIVES: To discuss challenges in the management of spinal bifida patients, who have marked kyphoscoliosis and no vascular access. SETTING: Regional Spinal Injuries Centre, Southport, UK. METHODS: A female patient, who was born with spina bifida, paraplegia and solitary right kidney, had undergone ileal loop urinary diversion. Renal calculi were noted in 1986. Percutaneous nephrostolithotomy was performed in 1989 and there was no residual stone fragment. However, she developed recurrence of calculi in the lower pole of the right kidney in 1991. Intravenous urography, performed in 1995, revealed right staghorn calculus and hydronephrosis. Chest X-ray showed markedly restricted lung volume due to severe kyphoscoliosis. In 2000, she was declared unsuitable for anaesthesia due to a lack of venous access and a high likelihood of difficulty in weaning off the ventilator in the postoperative period. In June 2002, she developed anuria (urine output=18 ml/24 h) due to ball-valve-type obstruction by a renal stone at the ureteropelvic junction. Urea: 14.4 mmol/l; creatinine: 236 microl/l. Ultrasound showed right hydronephrosis. Percutaneous nephrostomy was performed. RESULTS: Following relief of urinary tract obstruction, there was postobstructive diuresis (3765 ml/24 h). However, the patient expired 19 days later due to progressive respiratory failure. CONCLUSION: In this spina bifida patient, who had reached the age of 35 years, severe kyphoscoliosis and lack of vascular access presented insurmountable challenges to implement the desired surgical procedure for removal of stones from a solitary kidney.
Asunto(s)
Anuria/diagnóstico por imagen , Cálculos Renales/diagnóstico por imagen , Riñón/patología , Disrafia Espinal/diagnóstico por imagen , Adulto , Anuria/complicaciones , Anuria/cirugía , Femenino , Humanos , Riñón/anomalías , Cálculos Renales/complicaciones , Cálculos Renales/cirugía , Radiografía , Disrafia Espinal/complicaciones , Disrafia Espinal/cirugíaRESUMEN
The most frequent medical complication in patients with neurogenic bladder dysfunction is urinary tract infection (UTI). In the acute phase of neurogenic bladder, aseptic intermittent catheterization should be applied. After this phase, patients are subject to UTIs leading to febrile diseases. In the chronic phase of neurogenic bladders, febrile infections are often accompanied with hypertonic bladder. Some causes or symptoms prior to febrile attack are recognized in many of the cases. Antimicrobial chemotherapy has to be started in time without delay. Newer generation cephalosporins and carbapenems may shorten the febrile period. We report our experience with 229 patients treated between January 1993 and December 1998.
Asunto(s)
Antiinfecciosos Urinarios/uso terapéutico , Infecciones por Bacterias Gramnegativas/microbiología , Vejiga Urinaria Neurogénica/complicaciones , Infecciones Urinarias/etiología , Infecciones Urinarias/microbiología , Enfermedad Aguda , Carbapenémicos/uso terapéutico , Cefalosporinas/uso terapéutico , Enfermedad Crónica , Epididimitis/tratamiento farmacológico , Epididimitis/microbiología , Epididimitis/patología , Infecciones por Escherichia coli/tratamiento farmacológico , Infecciones por Escherichia coli/microbiología , Infecciones por Escherichia coli/patología , Femenino , Fiebre/tratamiento farmacológico , Fiebre/microbiología , Fiebre/patología , Infecciones por Bacterias Gramnegativas/tratamiento farmacológico , Infecciones por Bacterias Gramnegativas/patología , Humanos , Infecciones por Klebsiella/tratamiento farmacológico , Infecciones por Klebsiella/microbiología , Infecciones por Klebsiella/patología , Masculino , Prostatitis/tratamiento farmacológico , Prostatitis/microbiología , Prostatitis/patología , Infecciones por Pseudomonas/tratamiento farmacológico , Infecciones por Pseudomonas/microbiología , Infecciones por Pseudomonas/patología , Pielonefritis/tratamiento farmacológico , Pielonefritis/microbiología , Pielonefritis/patología , Vejiga Urinaria/microbiología , Vejiga Urinaria/patología , Vejiga Urinaria/cirugía , Vejiga Urinaria Neurogénica/tratamiento farmacológico , Cateterismo Urinario/efectos adversos , Infecciones Urinarias/tratamiento farmacológico , Infecciones Urinarias/patologíaAsunto(s)
Cuadriplejía/etiología , Traumatismos de la Médula Espinal/complicaciones , Enfermedades de la Vejiga Urinaria/terapia , Adulto , Humanos , Masculino , Cuadriplejía/rehabilitación , Traumatismos de la Médula Espinal/rehabilitación , Enfermedades de la Vejiga Urinaria/etiología , Cateterismo UrinarioRESUMEN
BACKGROUND: The ideal urological management for the patients with cervical spinal cord injury (CSCI) is to obtain catheter free urination and to prevent urinary tract complications. We have evaluated cases that had undergone transurethral anterior sphincterotomy from the view-point of the operative indications and the efficacy. METHODS: We carried out sphincterotomy 166 times on 133 male patients with CSCI in our Center. Before the operations were performed, all patients suffered from urinary incontinence, and they were unable to catheterize themselves for low level activity of daily life. Before and after the operation, their detrusor functions with sphincter reactions were assessed by urodynamic study. In principle we have followed up these cases by cystogram combined with cystometry, cystogram and excretory-pyelography or abdominal ultrasonography. RESULTS: In post-operative evaluations, more than 80% of cases attained hypotonic detrusor contractions and residual urine was significantly decreased. In long term follow-up, 96% of patients had obtained catheter free urination and about 85% of patients had no urinary tract complications, such as bladder deformity, vesicoureteral reflux, or hydronephrosis, with the exception of common unavoidable urinary infections. About 20% of cases had to be re-operated upon, and some cases showed hypertonic detrusor contractions or detrusor-sphincter-dyssynnergia during follow-up. CONCLUSION: The operative indications of sphincterotomy should be decided when the CSCI patients is unable to perform self-catheterization, and when due to the dysfunction of the urethral sphincter, these patients suffered from voiding difficulties or autonomic dysreflexia, or when the urinary tract complications might occur. In the majority of cases the aims of the sphincterotomy were achieved but some cases underwent another operation or had recurrent dysfunction of the urethral sphincter, indicating the need for careful follow-up.
Asunto(s)
Traumatismos de la Médula Espinal/complicaciones , Uretra/cirugía , Incontinencia Urinaria/etiología , Incontinencia Urinaria/cirugía , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Incontinencia Urinaria/fisiopatología , Urodinámica , Procedimientos Quirúrgicos Urológicos MasculinosAsunto(s)
Neuronas Motoras/fisiología , Paraplejía/complicaciones , Incontinencia Urinaria/etiología , Adulto , Incontinencia Fecal/etiología , Incontinencia Fecal/terapia , Humanos , Masculino , Paraplejía/fisiopatología , Radiografía , Incontinencia Urinaria/diagnóstico por imagen , Incontinencia Urinaria/terapia , Urodinámica , CaminataRESUMEN
The Injury Prevention Committee of the Japan Medical Society of Paraplegia (JMSoP) conducted a nationwide epidemiological survey on spinal cord injury (SCI) using postal questionnaires for 3 years periods from 1990 to 1992, and the annual incidence of the spinal cord injury was estimated as 40.2 per million. From this registry, we investigated SCI related to sports activities. In 3 years, 528 patients were registered and 374 of them had neurological deficits. The incidence was 1.95 per million per annum. Mean age at injury was 28.5 years (10-77), and 88.1% of the patients were males. Diving was the commonest cause of SCI (21.6%), which was followed by skiing (13.4%), football including rugby, American football and soccer (12.7%), sky sports (7.0%), judo (6.8%) and gymnastics (6.6%). Mean age at injury was higher than 30 years in skiing (38.6 years) and sky sports (38.2 years). Cervical injury was predominant in all but sky sports and accounted for 83.5% of SCI. Motor complete paralysis was reported in 35.0% of the patients. Bony injury was observed in 55.9% of the patients; most of the patients who sustained the SCI in diving and sky sports had bony injury, and no bony injury was detected in more than a half of the patients who sustained injuries in skiing, judo or gymnastics. Although the percentage of sports-related SCI was small in the present study as compared to the data from previous reports, it is not difficult to imagine the increase in the number of sports-related SCI. We have launched an injury prevention campaign and are planning to conduct a similar study in future to evaluate the effect of the campaign as well as the changes in the incidence and pattern of SCI.
Asunto(s)
Traumatismos en Atletas/epidemiología , Traumatismos de la Médula Espinal/epidemiología , Adolescente , Adulto , Anciano , Conducción de Automóvil , Aviación , Niño , Femenino , Fútbol Americano/lesiones , Gimnasia/lesiones , Humanos , Japón/epidemiología , Masculino , Persona de Mediana Edad , Parálisis/epidemiología , Parálisis/etiología , Esquí/lesiones , Lucha/lesionesRESUMEN
Urodynamic study of 66 patients with caudal injury and of 7 patients who underwent saddle block was evaluated by putting emphasis on the maximal pressure of the urethra (UPmax). The static pressure of 49.7 +/- 10.8 cm H2O in the membranous urethra of the patients with completely paralyzed sphincter raised the question that some active muscle that functions to open the membranous urethra must have been working during physiological urination. Urodynamic findings of detrusor sphincter relationship, monitored by pressure and electromyogram (EMG) measurement, suggested that the combined reflections of the pelvic floor muscle and urethral sphincter are present. We concluded that this would be induced by the transversus perinei profundus muscle contraction and the urodynamic interpretation would be re-integrated on the role of this muscle on active urethral opening mechanism.
Asunto(s)
Músculo Liso/fisiopatología , Paraplejía/fisiopatología , Traumatismos de la Médula Espinal/fisiopatología , Uretra/fisiopatología , Vejiga Urinaria Neurogénica/fisiopatología , Micción/fisiología , Anestesia Obstétrica/efectos adversos , Femenino , Humanos , Estudios Retrospectivos , UrodinámicaRESUMEN
To eliminate severe leg spasms of 15 quadriplegics, 0.3 ml 10% phenol-glycerin was injected into the subarachnoid space at the T12/L1 interspace. The effectiveness for leg spasm was evaluated by the Penn spasticity and Ashworth rigidity scales. Three patients remained completely flaccid; however three had slight, six had moderate and three had complete recurrence of spasms in a follow up period of observation for 1 to 22 (average 13) months. The result of selective intrathecal phenol block was significantly valuable, improving the activities of daily living (ADL) of quadriplegic patients. There were no systemic side effects nor disturbance of bladder, bowel or sexual functions.
Asunto(s)
Actividades Cotidianas , Bloqueo Nervioso , Fenoles , Cuadriplejía/terapia , Espasmo/terapia , Adulto , Anciano , Estudios de Seguimiento , Humanos , Inyecciones Espinales , Masculino , Persona de Mediana Edad , Cuadriplejía/complicaciones , Cuadriplejía/psicología , Recurrencia , Espasmo/etiología , Espasmo/psicologíaRESUMEN
During the last 10 years, 90 penile prostheses were implanted in 82 patients with spinal cord injury. Surgery was done 1 month to 25 years (average 4.8 years) after the injury. The follow up period ranged from 1 to 10 years (average 4 years). A prosthesis was implanted for urinary management in 51 patients (62%), for sexual dysfunction in 10 patients (12%) and for both purposes in 21 patients (26%). Ninety-three per cent of the patients who used the implant for urinary management and 64% of the patients who used it for sexual dysfunction were satisfactory. We experienced three extrusions and nine surgical removals due to pain, difficulty of catheterisation and infection (the complication rate was 13.3%). Generally speaking, a penile prosthesis improves the quality of life of patients with spinal cord injury significantly; however, extrusion and infection are still significant problems.
Asunto(s)
Disfunción Eréctil/terapia , Prótesis de Pene , Traumatismos de la Médula Espinal/complicaciones , Vejiga Urinaria Neurogénica/terapia , Adolescente , Adulto , Anciano , Disfunción Eréctil/etiología , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Prótesis de Pene/efectos adversos , Falla de Prótesis , Infecciones Relacionadas con Prótesis/fisiopatología , Vejiga Urinaria Neurogénica/etiologíaRESUMEN
A total of 68 ureteroneocystostomies performed between 1980 and 1992 in 63 patients with vesicoureteral reflux (UVR) secondary to neurogenic bladder were reviewed to elucidate factors of postoperative hydronephrosis. Urogram, cystogram, and urodynamics were analyzed, and the cases were classified into two types (areflexia, hyperreflexia) of detrusor muscle response. Occurrence or progression of hydronephrosis was demonstrated in 26 operations (complicated group). Compared with the rest (uncomplicated group), significant difference was not observed concerning proportions of vesical deformity, VUR grades, preoperative hydronephrosis, cystometric types and operative factors. In cases of hyperreflexia maximum vesical volume, maximum vesical pressure or maximum urethral pressure was not different between both groups. However, in those of areflexia maximum vesical volume of the complicated group was significantly smaller than that of the uncomplicated group (290 +/- 35 ml vs. 370 +/- 35 ml, P = 0.03), and the proportion of bladders with compliance less than 10 ml/cmH2O was significantly higher in the complicated group than in the uncomplicated group (P = 0.05) though maximum vesical pressure or maximum urethral pressure was not different. In areflex bladder deformity was observed more in the complicated group than in the uncomplicated group (P = 0.06). Relative inactiveness of detrusor muscle in areflex bladder might render such preoperative findings as vesical deformity, contracted bladder and low compliance more prognosticative of postoperative hydronephrosis than in hyperreflex bladder. During the follow up (6 to 132, mean 42 months) no case showed progression of hydronephrosis or renal deterioration, nor did any case require revisional surgery.(ABSTRACT TRUNCATED AT 250 WORDS)
Asunto(s)
Cistostomía , Hidronefrosis/etiología , Complicaciones Posoperatorias , Uréter/cirugía , Vejiga Urinaria Neurogénica/cirugía , Adolescente , Adulto , Anciano , Anastomosis Quirúrgica , Niño , Preescolar , Cistostomía/métodos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Factores de Riesgo , Vejiga Urinaria Neurogénica/complicaciones , Reflujo Vesicoureteral/etiología , Reflujo Vesicoureteral/cirugíaRESUMEN
From 1979 to 1989, 269 patients with spinal cord injury were managed by an aseptic intermittent catheterization program during the acute phase of their injuries at the Spinal Injuries Center. One hundred fifty one patients with incomplete cord lesion and 36 males with complete tetraplegia were managed by program I, which protects the shocked bladder from overdistention. In contrast, 82 patients with complete cord lesion excluding male tetraplegia were managed by program II, which allows overdistention of the bladder. Of the 187 patients managed by program I, 137 (73.3%) achieved trigger voiding function, 61.3% of whom were completely dry. Of the 82 patients managed by program II, 62 (75.6%) were put to self- or assisted catheterization, 67.7% of whom were dry. The incidence of a grade I, which means normal bladder configuration, was 88.0% for program I and 87.3% for program II during the follow up course. Upper urinary tract deterioration occurred in only one case. Surgical treatment for urinary tract complications was performed in 14 cases (5.2%). These results suggest that the patients with incomplete cord lesion managed by non-distension regimen of the bladder (program I) and those, especially female, with complete cord lesion managed by overdistention regimen of the bladder (program II) achieve urinary continence with excellent urinary prognosis.
Asunto(s)
Traumatismos de la Médula Espinal/terapia , Cateterismo Urinario , Incontinencia Urinaria/prevención & control , Humanos , Masculino , Traumatismos de la Médula Espinal/complicaciones , Vejiga Urinaria/fisiopatologíaRESUMEN
The urinary N-acetyl-beta-D-glucosaminidase (NAG) activities were determined in acute pyelonephritis patients with spinal cord injuries. The urinary NAG activity was significantly elevated in 23 of 31 cases (74%) compared with normal controls. Out of 7 acute pyelonephritis patients without spinal cord injuries, 4 patients (57%) showed significantly elevated urinary NAG activities. The urinary NAG activities were within normal range in 20 patients with acute simple cystitis and 11 patients with chronic complicated cystitis. Out of 6 patients with urethritis, only one case (17%) showed a significantly higher level of urinary NAG activity. Significantly higher levels in urinary NAG activities were observed in 6 of 9 patients (67%) with acute prostatitis and 5 of 9 patients (56%) with acute epididymitis. In patients with spinal cord injuries, having frequent urinary tract infections and complicated pathophysiological conditions, urinary NAG is one of the helpful laboratory findings for the diagnosis of acute pyelonephritis.
Asunto(s)
Acetilglucosaminidasa/orina , Pruebas Enzimáticas Clínicas , Hexosaminidasas/orina , Pielonefritis/diagnóstico , Traumatismos de la Médula Espinal/complicaciones , Enfermedad Aguda , Adolescente , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Pielonefritis/complicacionesAsunto(s)
Traumatismos de la Médula Espinal/complicaciones , Vejiga Urinaria Neurogénica/terapia , Cateterismo Urinario/métodos , Adolescente , Adulto , Anciano , Niño , Preescolar , Enfermedad Crónica , Estudios de Evaluación como Asunto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Autocuidado/métodosRESUMEN
During the last 5 years non-inflatable penile prostheses were implanted in 37 patients with spinal cord injury. Operation was done to provide adequate stability of the penis in order to hold an external urinary device, to help erectile impotence and to make self-catheterisation easier. A pair of Shirai-type silicone penile implants were inserted into the corpora cavernosa through a dorsal skin incision at the penile base. In 37 patients 33 had excellent results. Extrusion of the prosthesis occurred in two cases due to infection. Removal of the prosthesis was necessary in a patient who had causalgia in the lower extremities. Posterior migration of the prosthesis was noted in a tetraplegic patient who used to turn on his stomach when he changed clothes. Anterior sphincterotomy which was performed during the surgery in one case and after the surgery in another two cases did not affect the prosthesis. Questionnaire survey revealed that 32 (86%) were satisfied with the procedure which provided better condom fitting and easier intermittent catheterisation whereas only 5 (14%) were dissatisfied. The prosthesis improved sexual function in 15 (41%) patients, 18 (48%) patients were unchanged and four (11%) patients were dissatisfied. Penile prosthesis is an effective manoeuvre for the treatment of urinary incontinence and sexual disability of patients with spinal cord injury provided that the special aspects of the spinal cord injury is taken into consideration.