RESUMEN
A bexiga neurogênica, frequentemente associada à lesão medular de causa traumática e não traumática, é uma disfunção vesical decorrente de alterações no sistema nervoso. Este estudo investigou e analisou a bexiga neurogênica, sua prevalência e manejo em pessoas com diagnóstico de lesão medular traumática (LMT) e não traumática (LMNT) em uma rede de hospitais de reabilitação. Tratou-se de um estudo quantitativo, transversal, exploratório, descritivo e analítico. Para responder à questão central do estudo, foi selecionada uma amostra com 954 participantes, probabilística, aleatória estratificada, das seis unidades da rede participantes do estudo, com dados coletados diretamente dos prontuários eletrônicos. A prevalência de bexiga neurogênica foi de 94,65% (n=903), 67% tinham diagnóstico de lesão medular traumática e 33% de lesão medular não traumática, 69,32% eram homens e 30,68%, mulheres, com média de idade de 46,12 anos (DP=13,26). O cateterismo vesical intermitente foi a principal forma de esvaziamento (66,11%), e a maioria realizava o autocateterismo intermitente (74,04%). A micção voluntária foi associada ao tipo de lesão, sendo mais prevalente entre os participantes com LMNT (p≤0,001, Teste Qui-quadrado). Para investigação urológica, 93,36% realizaram exames de ultrassonografia renal e vias urinárias e 87,82%, estudo urodinâmico. A irregularidade da parede vesical (p≤0,029, teste Qui-quadrado de Pearson), o espessamento vesical (p ≤ 0,001, teste Qui-quadrado de Pearson) e a hiperatividade detrusora (p≤0,009, teste Qui-quadrado de Pearson) também apresentaram diferença estatística de acordo com o tipo de lesão, mais prevalentes nos participantes com LMT. Assim como a dilatação pielocalicinal, mais prevalente nos participantes com LMNT (p≤0,025, teste Qui-quadrado de Pearson). Os participantes com LMT apresentaram maior pressão detrusora média, 38,73cmH2O vs. 30,17cmH2O do que os com LMNT (p ≤ 0,001, teste de Mann- Whitney). Sabe-se que a bexiga neurogênica de pessoas com lesão medular traumática tende a apresentar maior número de complicações e maior risco para o trato urinário superior, principalmente quando há relação com a presença de pressão elevada, baixa complacência e capacidade vesical reduzida. Este estudo evidenciou diferenças importantes entre o perfil de pessoas com lesão medular traumática e não traumática, mostrando a necessidade do manejo personalizado de acordo com a causa da lesão medular.
Neurogenic bladder is a dysfunction that results from changes in the nervous system, and is frequently associated with traumatic and non-traumatic spinal cord injuries. This study investigated and analyzed the neurogenic bladder, its prevalence and management in people diagnosed with traumatic spinal cord injury (TSCI) and non-traumatic spinal cord injury (NTSCI) in a network of rehabilitation hospitals. This is a quantitative, transversal, exploratory, descriptive and analytical study. A probabilistic, stratified random sample, composed of 954 participants, was used to answer the research question. Participants were selected from six of the hospital-network units and data were directly retrieved from electronic medical records. The prevalence of neurogenic bladder was 94.65% (n = 903), where 67% had a diagnosis of traumatic spinal cord injury and 33% non-traumatic spinal cord injury, 69.32% were male and 30.68% female, with a mean age of 46.12 years (SD = 13.26). The main draining method was intermittent bladder catheterization (66.11%), in most cases performed as intermittent self-catheterization (74.04%). Voluntary urination was associated with the type of injury, being more prevalent among participants with non-traumatic spinal cord injury (NTSCI) (p≤0.001, Chi- Square Test). For urological investigation, 93.36% of the participants were submitted to a renal and urinary-tract ultrasound scan and 87.82% to urodynamics. Bladder wall irregularity (p≤0.029, Pearson's chi-square test) and thickening (p ≤ 0.001, Pearson's chi-square test), and detrusor hyperactivity (p≤0.009, Pearson's chi-square test) also presented a statistical difference according to the type of injury, with a higher prevalence in participants with traumatic spinal cord injury (TSCI). That was also the case of pyelocaliceal dilation, which was more prevalent in participants with NTSCI (p≤0.025, Pearson's Chi-square test). Participants with TSCI showed a mean detrusor pressure of 38.73 cmH2O, higher than the value of 30.17 cmH2O recorded for those with NTSCI (p ≤ 0.001, Mann-Whitney test). It is known that a neurogenic bladder in people with traumatic spinal cord injury tends to have a greater number of complications and greater risk for the upper urinary tract, especially when there is a relationship with the presence of high pressure, low compliance and reduced bladder capacity. This study unveiled important differences in the profiles of people with traumatic and non-traumatic spinal cord injury, highlighting the need for treatment to be tailored according to the cause of the spinal cord injury.
Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Traumatismos de la Médula Espinal , Vejiga Urinaria Neurogénica/tratamiento farmacológico , Vejiga Urinaria Neurogénica/rehabilitación , Vejiga Urinaria Neurogénica/epidemiología , Registros Electrónicos de SaludRESUMEN
AIM: To evaluate the performance of the new device compared with clean intermittent catheterization (CIC). METHODS: From March 2015 to March 2018, patients who were admitted to the urologic outpatient clinic. A new intraurethral self-retaining device (ISRD) was made of medical grade silicone and it was inspired by similar catheters that use sliding disks to adjust or fix tubes used to drain the bladder. Patients were randomized into two groups (experimental group [GI]-ISRD vs control group [GII]-CIC). The evaluation was performed at the time of enrollment and 6 months after treatment. Intervention was initiated from the antisepsis of the perineal region and subsequent introduction of the device through the external urethral meatus. The primary outcome was quality of life (QOL). Urinary tract infections (UTIs) episodes, data on urodynamic parameters, adverse effects and number of diapers per day. RESULTS: A total of 177 subjects were analyzed. We found a significant improvement on QOL analysis in the ISRD group (P < .01). ISRD group presented an important reduction (two episodes after ISRD use) on number of UTIs (P < .01) and diaper use, and significant improvement on bladder capacity (80 mL of the average improvement) (P < .01) and compliance (P = .01). Among all registered serious adverse effects, ISRD presented with lower proportion. CONCLUSIONS: The new device has shown to be a safe and promising alternative for adequate emptying of the neurogenic bladder in female patients. Our study has a limitation that is related to a limited period of observation.
Asunto(s)
Equipos y Suministros , Vejiga Urinaria Neurogénica/rehabilitación , Micción , Adolescente , Adulto , Antiinfecciosos Locales/uso terapéutico , Niño , Femenino , Humanos , Pañales para la Incontinencia/estadística & datos numéricos , Cateterismo Uretral Intermitente , Persona de Mediana Edad , Cooperación del Paciente , Estudios Prospectivos , Calidad de Vida , Resultado del Tratamiento , Vejiga Urinaria Neurogénica/complicaciones , Vejiga Urinaria Neurogénica/psicología , Cateterismo Urinario , Infecciones Urinarias/epidemiología , Infecciones Urinarias/etiología , UrodinámicaRESUMEN
Objectives: measure and compare the quality of life of neurogenic bladder patients using intermittent urinary catheterization who were going through rehabilitation in Brazil and Portugal. Method: multicenter, quantitative, cross-sectional, observational-analytic and correlational study executed in Brazil and Portugal. Two data collection tools were used, being one questionnaire with sociodemographic and clinical data and the World Health Organization Quality of Life-bref. Patients were included who were over 18 years of age, suffering from neurogenic urinary bladder and using intermittent urinary catheterization. Results: in the sample of Brazilian (n = 170) and Portuguese (n = 52) patients, respectively, most patients were single (87-51.2%; 25-48.1%), had finished primary education (47-45.3%; 31-59.6%) and were retired (70-41.2%; 21-40.4%). Spinal cord injury was the main cause of using the urinary catheter in both countries. The Brazilian patients presented higher mean quality of life scores in the psychological domain (68.9) and lower scores in the physical domain (58.9). The Portuguese patients presented higher scores in the psychological domain (68.4) and lower scores in the environment domain (59.4). The execution of intermittent urinary self-catheterization was significant for both countries. Conclusions: in the two countries, these patients' quality of life can be determined by the improvement in the urinary symptoms, independence, self-confidence, social relationships and access to work activities.
Asunto(s)
Cateterismo Uretral Intermitente , Calidad de Vida , Vejiga Urinaria Neurogénica/rehabilitación , Adulto , Anciano , Anciano de 80 o más Años , Brasil , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Portugal , Adulto JovenRESUMEN
ABSTRACT Objectives: measure and compare the quality of life of neurogenic bladder patients using intermittent urinary catheterization who were going through rehabilitation in Brazil and Portugal. Method: multicenter, quantitative, cross-sectional, observational-analytic and correlational study executed in Brazil and Portugal. Two data collection tools were used, being one questionnaire with sociodemographic and clinical data and the World Health Organization Quality of Life-bref. Patients were included who were over 18 years of age, suffering from neurogenic urinary bladder and using intermittent urinary catheterization. Results: in the sample of Brazilian (n = 170) and Portuguese (n = 52) patients, respectively, most patients were single (87-51.2%; 25-48.1%), had finished primary education (47-45.3%; 31-59.6%) and were retired (70-41.2%; 21-40.4%). Spinal cord injury was the main cause of using the urinary catheter in both countries. The Brazilian patients presented higher mean quality of life scores in the psychological domain (68.9) and lower scores in the physical domain (58.9). The Portuguese patients presented higher scores in the psychological domain (68.4) and lower scores in the environment domain (59.4). The execution of intermittent urinary self-catheterization was significant for both countries. Conclusions: in the two countries, these patients' quality of life can be determined by the improvement in the urinary symptoms, independence, self-confidence, social relationships and access to work activities.
RESUMO Objetivos: mensurar e comparar a qualidade de vida de pacientes com bexiga neurogênica em uso do cateterismo urinário intermitente em processo de reabilitação, no Brasil e em Portugal. Método: estudo multicêntrico, Brasil e Portugal, quantitativo, transversal, observacional-analítico e correlacional. Foram utilizados dois instrumentos de coleta, um questionário de dados sociodemográficos e clínicos e World Health Organization Quality Life-bref. Foram inclusos pacientes maiores de 18 anos, com bexiga urinária neurogênica, e usuários do cateterismo urinário intermitente. Resultados: na amostra de pacientes brasileiros (n = 170) e portugueses (n = 52), respectivamente, a maioria era solteira (87-51,2%; 25-48,1%), com ensino fundamental (47-45,3%; 31-59,6%), aposentada (70-41,2%; 21-40,4%). A lesão medular foi a principal causa do uso do cateter urinário nos dois países. Os pacientes brasileiros apresentaram média de escores mais elevados de qualidade de vida no domínio psicológico (68,9) e menos elevados no domínio físico (58,9). Os pacientes portugueses apresentaram escores mais elevados no domínio psicológico (68,4) e menos no domínio ambiente (59,4). A realização do autocateterismo urinário intermitente foi significativa para os dois países. Conclusões: nos dois países, a qualidade de vida desses pacientes pode ser determinada pela melhora dos sintomas urinários, da independência, autoconfiança, relações sociais e acesso a atividades laborais.
RESUMEN Objetivos: mensurar y comparar la calidad de vida de pacientes con vejiga neurogénica en uso de cateterismo vesical intermitente durante el proceso de rehabilitación en Brasil y en Portugal. Método: estudio multicéntrico, Brasil y Portugal, cuantitativo, trasversal, observacional-analítico y correlacional. Fueron utilizados dos instrumentos de recolecta, un cuestionario de datos sociodemográficos y clínicos y el World Health Organization Quality Life-bref. Fueron inclusos pacientes mayores de 18 años, con vejiga urinaria neurogénica, y usuarios de cateterismo vesical intermitente. Resultados: en la muestra de pacientes brasileños (n = 170) y portugueses (n = 52), respectivamente, la mayoría era soltera (87-51,2%; 25-48,1%), con educación fundamental (47-45,3%; 31-59,6%), jubilada (70-41,2%; 21-40,4%). La lesión medular fue la principal causa del uso del catéter urinario en los dos países. En promedio, los pacientes brasileños presentaron scores de calidad de vida superiores en el dominio psicológico (68,9) e inferiores en el dominio físico (58,9). Los pacientes portugueses presentaron scores superiores en el dominio psicológico (68,4) y inferiores en el dominio ambiente (59,4). La ejecución del autocateterismo vesical intermitente fue significativa para los dos países. Conclusiones: en los dos países, la calidad de vida de esos pacientes puede ser determinada por la mejora de los síntomas urinarios, de la independencia, autoconfianza, relaciones sociales y acceso a actividades laborales.
Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Adulto Joven , Calidad de Vida , Vejiga Urinaria Neurogénica/rehabilitación , Cateterismo Uretral Intermitente , Portugal , Brasil , Estudios TransversalesRESUMEN
AIMS AND BACKGROUND: The rehabilitation process of patients with neurogenic bladder involves psychosocial, cultural, political and economic human factors, representing a challenge for patients/caregivers as well as health professionals. This study was aimed at characterizing patients with neurogenic bladder who use intermittent urethral catheterization and were going through rehabilitation at a teaching hospital. METHOD: This descriptive study was undertaken in the interior of São Paulo State-Brazil. All ethical guidelines were complied with. To collect the data, interviews were held during nursing consultations with patients more than 18years of age suffering from neurogenic bladder who used intermittent urethral catheterization. RESULTS: Most patients had spinal cord trauma, are single, male and gain a low income. They have been using catheterization for several years, at irregular frequencies, using polyethylene catheters. CONCLUSIONS: No standardization exists in the accomplishment of the practices used and strategies are needed to remodel the service.
Asunto(s)
Vejiga Urinaria Neurogénica/terapia , Cateterismo Urinario , Brasil , Femenino , Humanos , Masculino , Uretra , Vejiga Urinaria Neurogénica/rehabilitaciónRESUMEN
Los programas de adiestramiento o reeducación vesical son esenciales para el éxito de las metas de rehabilitación final de cada persona. Estos programas deben incorporarse al plan total de asistencia de enfermería, de modo que todos los tur- nos de personal de enfermería asistan al paciente en unaforma coherente y significativa. Por supuesto, si el paciente alcanza finalmente el control de la vejiga dependerá de la causa de la pérdida de su control, del grado de lesión cerebraly de las infecciones u otras complicaciones que existan. Laintervención de la enfermera en esta cuestión debe individua- lizarse, ser ingeniosa y rigurosa.
Asunto(s)
Humanos , Masculino , Adulto , Traumatismos de la Médula Espinal/complicaciones , Traumatismos de la Médula Espinal/psicología , Traumatismos de la Médula Espinal/rehabilitación , Cateterismo Urinario , Defecación , Disfunción Eréctil , Vejiga Urinaria Neurogénica/enfermería , Vejiga Urinaria Neurogénica/psicología , Vejiga Urinaria Neurogénica/rehabilitaciónRESUMEN
Spinal cord injury leads to a severe disabling syndrome, which most often affects the young. The major etiologic factor in spinal cord injuries is trauma. Patients' rehabilitation is started in the acute phase, soon after the trauma occurs, mainly through preventive care against the formation of pressure sores, deformities of the palsy segments, proper vesical and bowel emptying and care with vasomotor alterations. The rehabilitation process continues at a specialized rehabilitation center, searching the best functional performance of each patient, according to the type and level of the spinal cord injury. This work shows fundaments for the rehabilitation treatment.