Presentation on theme: "Neurogenic bladder in patients with spinal cord lesion"— Presentation transcript:
1 Neurogenic bladder in patients with spinal cord lesion 2007JJ WyndaeleMD DBMSci PhD FEBU FISCOS
2 Prevalence neurogenic bladder in spinal lesion Myelodysplasia 90% -97%(Smith 1965)Spinal stenosis61-62%(Tammela et al 1992, Kawaguchi 2001)Spine surgery38%-60%(Boulis et al 2001, Brooks, ME 1985)Disc disease28%-87%(Bartolin et al 1999, O’Flynn et al 1992)Spinal cord injury? majority
31 Indwelling catheters Short-term ID during the acute phase Transurethral ID not safe for long-term use in neuropathic patientsBladder screening for bladder cancer is mandatory especially in those with ID/SC more than 5-10 years.
32 Less urethral complications Suprapubic catheterLess urethral complications
33 Condom Catheter Long-term use does not increase the risk of UTI Complications less if good hygiene care, frequently change CC and low bladder pressures.
35 Surgery to increase detrusor contractility + abolish reflex activity SARS + Dorsal Rhizotomy
36 Possible alternatives to avoid rhizotomy: under research Selective anodal blockCryotherapy deafferentationSPARSI (anterior + posterior rooths)
37 Surgery decrease outlet resistance TUI sphincterIntraurethral stentsBotulinum Toxin
38 Surgery to lower detrusor contractility – intravesical pressure Botulinum Toxin in detrusorEnterocystoplastyAutoaugmentation
39 Surgery to increase sphincter resistance Artificial urinary sphincterSling proceduresResorbable or non –resorbable bulking agents
40 DiversionAcceptable treatment in selected cases
41 Future ? Restoring function by nerve transplants? Cell therapy ? Stem cell therapy ?
42 4. Follow-up Lifelong every 1 – 2 years Must include Imaging UT / function UTUrineBlood(Urodynamics)
43 Quality of life (meta-analysis) SCI significantly lower in all subscales compared with normative populationNeurogenic pain, spasticity, and neurogenic bladder and bowel problems give lower QL scores.
44 Quality of life in primary caregivers (meta-analysis) significantly lower compared to age-matched healthy population based controlsNo significant relation was demonstrated with the duration of injury, lesion levels, ASIA scores, degree of spasticity, bladder and/or bowel incontinence and pressure sores respectively.
45 Causes for readmission “The leading cause of rehospitalization are diseases of the genitourinary system, including urinary tract infections”Cardenas et al Arch Physic Med Rehab 2004
46 Do spinal cord injury patients always get the best treatment for neuropathic bladder after discharge from regional spinal injuries centre?Vaidyanathan et al Spinal Cord 2004
47 ConclusionsUrinary problems less dangerous for life expectancy than some decades agoFollow up life longUrinary problems still very much influencing quality of lifeBladder management cross-disciplinary workPatient is centralDo not forget relatives