1
|
Joshi AD, Shukla A, Chawathe V, Gaur AK. Clean intermittent catheterization in long-term management of neurogenic bladder in spinal cord injury: Patient perspective and experiences. Int J Urol 2022; 29:317-323. [PMID: 35018670 DOI: 10.1111/iju.14776] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 12/12/2021] [Indexed: 01/15/2023]
Abstract
OBJECTIVES Bladder dysfunction due to spinal cord injury has a significant impact on the overall health and quality of life of an individual. Clean intermittent catheterization is the gold standard for bladder management and is recommended due to having the lowest complication rate. Transitions from intermittent catheterization to other less optimal strategies, such as indwelling catheter, are quite common. However, the research documenting patient perspectives, and epidemiological and demographic factors related to such transition is limited. METHODS Data from patients with spinal cord injury rehabilitated with clean intermittent catheterization were collected. Demographic and epidemiological details of the patients were documented from the inpatient records. Appropriate statistical tests were applied to the values. RESULTS Among the 45 participants, 68.89% continued clean intermittent catheterization. In those who discontinued clean intermittent catheterization, the median duration of practicing clean intermittent catheterization was 3.5 months. The commonest difficulty among compliant patients was carrying out clean intermittent catheterization in outdoor environments due to the unavailability of toilet facilities. Urinary tract infection was the most common (17.78%) complication noted. Dependence (20.00%) was a major procedural difficulty followed by pain. Adaptations to remain continent in special conditions were diapers and condom catheters. The duration of clean intermittent catheterization practiced influenced discontinuation of clean intermittent catheterization. With an increase in the duration of clean intermittent catheterization practiced after discharge, the risk of discontinuation of clean intermittent catheterization decreased with an adjusted odds ratio of 0.773 (95% confidence interval 0.609-0.982). CONCLUSIONS People with spinal cord injury have many challenging issues in the regulation of bladder function at their level inclusive of procedural difficulties, environmental barriers and medical complications, and understanding of which will help to establish a comprehensive and a holistic program to provide remote/community care.
Collapse
Affiliation(s)
- Ameya Deepak Joshi
- Department of Physical Medicine and Rehabilitation, All India Institute of Physical Medicine and Rehabilitation, Mumbai, India
| | - Aradhana Shukla
- Department of Physical Medicine and Rehabilitation, All India Institute of Physical Medicine and Rehabilitation, Mumbai, India
| | - Vivek Chawathe
- Department of Physical Medicine and Rehabilitation, All India Institute of Physical Medicine and Rehabilitation, Mumbai, India
| | - Anil Kumar Gaur
- Department of Physical Medicine and Rehabilitation, All India Institute of Physical Medicine and Rehabilitation, Mumbai, India
| |
Collapse
|
2
|
AlSaleh AJ, Qureshi AZ, Abdin ZS, AlHabter AM. Long-term compliance with bladder management in patients with spinal cord injury: A Saudi-Arabian perspective. J Spinal Cord Med 2018; 43:374-379. [PMID: 30346256 PMCID: PMC7241560 DOI: 10.1080/10790268.2018.1531609] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
Objective: To examine long-term compliance with bladder management in patients with spinal cord injury (SCI) at a tertiary care rehabilitation facility in Saudi Arabia.Design: Cross-sectional survey.Setting: Tertiary care rehabilitation facility in Saudi Arabia.Participants: A self-administered questionnaire was distributed to patients with SCI during their clinic visits. 50 patients (41 males and nine females) participated in the survey. Data documentation included demographic characteristics, type and level of injury, compliance with bladder management and barriers in compliance.Main outcome measures: The type of bladder management employed at first follow-up visit was compared with that employed at discharge.Results: Eleven out of 41 patients who were discharged on clean intermittent catheterization (CIC) stopped it within 3 months of discharge, mainly due to lack of accessibility and financial support to buy catheters. Of the total sample, 23% reported that they did not know the difference between catheter types and their advantages, and 49% stated that they did not receive proper health education regarding bladder management.Conclusion: CIC was the most commonly used bladder management technique in patients with SCI following up at a tertiary care rehabilitation facility in Saudi Arabia. Compliance with CIC may be improved by ensuring access to catheters post-discharge and by providing appropriate education about bladder management during inpatient rehabilitation.
Collapse
Affiliation(s)
- Anas Jehad AlSaleh
- Department of Physical Medicine & Rehabilitation, King Fahad Medical City, Riyadh, Saudi Arabia,Correspondence to: Anas Jehad AlSaleh, Department of Physical Medicine & Rehabilitation, King Fahad Medical City, Riyadh, Saudi Arabia.
| | - Ahmad Zaheer Qureshi
- Department of Physical Medicine & Rehabilitation, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Zilal Syamsuddin Abdin
- Department of Physical Medicine & Rehabilitation, King Fahad Medical City, Riyadh, Saudi Arabia
| | | |
Collapse
|
3
|
Kreydin E, Welk B, Chung D, Clemens Q, Yang C, Danforth T, Gousse A, Kielb S, Kraus S, Mangera A, Reid S, Szell N, Cruz F, Chartier-Kastler E, Ginsberg DA. Surveillance and management of urologic complications after spinal cord injury. World J Urol 2018; 36:1545-1553. [PMID: 29845320 DOI: 10.1007/s00345-018-2345-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 05/17/2018] [Indexed: 12/12/2022] Open
Abstract
PURPOSE Neurogenic bladder due to spinal cord injury has significant consequences for patients' health and quality of life. Regular surveillance is required to assess the status of the upper and lower urinary lower urinary tracts and prevent their deterioration. In this review, we examine surveillance techniques in neurogenic bladder, describe common complications of this disease, and address strategies for their management. METHODS This work represents the efforts of SIU-ICUD joint consultation on Urologic Management of the Spinal Cord injury. For this specific topic, a workgroup was formed and comprehensive literature search of English language manuscripts regarding neurogenic bladder management was performed using key words of neurogenic bladder. Articles were compiled, and recommendations in the chapter are based on group discussion and follow the Oxford Centre for Evidence-based Medicine system for Levels of Evidence (LOEs) and Grades of Recommendation (GORs). RESULTS At a minimum, patients should undergo an annual history and physical examination, renal functional testing (e.g., serum creatinine), and upper tract imaging (e.g., renal ultrasonography). The existing evidence does not support the use of other modalities, such as cystoscopy or urodynamics, for routine surveillance. Urologic complications in neurogenic bladder patients are common and often more complex than in the general population. CONCLUSIONS There is a shortage of high-quality evidence to support any particular neurogenic bladder surveillance protocol. However, there is consensus regarding certain aspects of regular genitourinary system evaluation in these patients. Proper surveillance allows the clinician to avoid or address common urological complications, and to guide, alter, or maintain appropriate therapeutic regimens for individual patients.
Collapse
Affiliation(s)
- Evgeniy Kreydin
- USC Institute of Urology, 1441 Eastlake Avenue, suite 7414, Los Angeles, CA, 90033, USA
| | - Blayne Welk
- Division of Urology, The University of Western Ontario, London, ON, Canada
| | - Doreen Chung
- Columbia University College of Physicians and Surgeons, New York, NY, USA
| | | | | | - Teresa Danforth
- Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, USA
| | - Angelo Gousse
- Bladder Health and Reconstructive Urology Institute, Miami, FL, USA
| | | | - Stephen Kraus
- University of Texas, San Antonio, San Antonio, TX, USA
| | - Altaf Mangera
- Department of Urology, Pitié-Salpêtrière, Paris, France
| | | | - Nicole Szell
- Bladder Health and Reconstructive Urology Institute, Miami, FL, USA
| | - Francisco Cruz
- Department of Urology, Hospital de São João, Porto, Portugal
| | | | - David A Ginsberg
- USC Institute of Urology, 1441 Eastlake Avenue, suite 7414, Los Angeles, CA, 90033, USA.
| |
Collapse
|
4
|
Sugiyama H, Uemura O, Mori T, Okisio N, Unai K, Liu M. Effect of imidafenacin on the urodynamic parameters of patients with indwelling bladder catheters due to spinal cord injury. Spinal Cord 2017; 55:187-191. [PMID: 27897185 PMCID: PMC5308215 DOI: 10.1038/sc.2016.168] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Revised: 09/23/2016] [Accepted: 10/19/2016] [Indexed: 11/10/2022]
Abstract
STUDY DESIGN A retrospective study. OBJECTIVES To investigate the effect of imidafenacin on the urodynamic parameters of patients with indwelling bladder catheters due to spinal cord injury (SCI). SETTING Spinal center (Tokyo, Japan). METHODS Imidafenacin was prescribed to 34 patients with SCI who had a low cystometric volume and/or detrusor compliance according to a urodynamic study. A low cystometric volume and detrusor compliance were defined as <200 ml and <20 ml cm-1 H2O, respectively. The urodynamic study was repeated 4 weeks after imidafenacin was prescribed. When the urodynamic parameters did not improve in the follow-up study, the dose of imidafenacin was increased twofold. Then the urodynamic study was repeated 4 weeks thereafter. We compared the urodynamic parameters before and after imidafenacin treatment. Complications such as vesico-urethral reflux (VUR) and autonomic dysreflexia (AD) were documented. RESULTS Fifteen patients took 0.2 mg of imidafenacin daily, and 19 received 0.4 mg of imidafenacin daily. Imidafenacin increased the cystometric volume from 246.0 to 321.5 ml (median, P=0.002), detrusor compliance from 6.67 ml cm-1 H2O to 8.98 ml cm-1 H2O (median, P=0.012), and decreased the detrusor pressure from 37.0 cm H2O to 30.5 cm H2O (median, P=0.056). All three patients who had VUR fully recovered. Although 3 of 12 patients recovered from AD, 3 patients newly developed symptoms of AD. No patient withdrew from treatment due to adverse effects. CONCLUSION Imidafenacin is a safe drug that may improve the urodynamic parameters of patients with SCI, and it possibly alleviates bladder complications.
Collapse
Affiliation(s)
- H Sugiyama
- National Hospital Organization Murayama Medical Center, Tokyo, Japan
| | - O Uemura
- National Hospital Organization Murayama Medical Center, Tokyo, Japan
| | - T Mori
- National Hospital Organization Murayama Medical Center, Tokyo, Japan
| | - N Okisio
- National Hospital Organization Murayama Medical Center, Tokyo, Japan
| | - K Unai
- National Hospital Organization Murayama Medical Center, Tokyo, Japan
| | - M Liu
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan
| |
Collapse
|
5
|
Afsar SI, Yemisci OU, Cosar SNS, Cetin N. Compliance with clean intermittent catheterization in spinal cord injury patients: a long-term follow-up study. Spinal Cord 2013; 51:645-9. [PMID: 23752262 DOI: 10.1038/sc.2013.46] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2013] [Revised: 04/01/2013] [Accepted: 04/23/2013] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Retrospective review of medical notes. OBJECTIVE To evaluate spinal cord injury (SCI) patients' compliance with bladder emptying method at long-term period after discharge and determine the frequency of urinary tract infections (UTIs). SETTING Inpatient rehabilitation unit of tertiary research hospital. METHODS Bladder management method of 164 new spinal cord injured patients were noted at discharge from rehabilitation center and follow-up. Patients were questioned whether they continued the initial bladder emtying method at follow-up, reasons for discontinuation and the history of treated UTIs. RESULTS The most common bladder management method at discharge from inpatient rehabilitation center was clean intermittent catheterization (CIC) (63.4%). At follow-up 42% of the patients who used CIC changed their bladder emptying method. Rate of reverting to urethral indwelling catheter (IC) was 21.4%. Reasons for the patients who switched to IC application were recurrent UTIs, incontinence, nephrolithiasis, dependence on care givers and urethral strictures. For all patients, the frequency of treated UTI in 1 year was 38.8%. The number of UTIs were highest in patients using IC. CONCLUSION Many factors, including urological complications, patient's preference, living environment, life-style and level of injury should be considered in deciding the method of bladder management in SCI patients. The CIC is a reliable and effective method in selected SCI patients. Despite changes in bladder emptying method, CIC was the most preferred method at long-term follow-up. Education of patients on catheterization technique and periodic follow-up is necessary to maintain patient compliance.
Collapse
Affiliation(s)
- S I Afsar
- Department of Physical and Rehabilitation Medicine, Faculty of Medicine, Baskent University, Ankara, Turkey.
| | | | | | | |
Collapse
|
6
|
Barriers, Complications, Adherence, and Self-reported Quality of Life for People Using Clean Intermittent Catheterization. J Wound Ostomy Continence Nurs 2013; 40:83-9. [DOI: 10.1097/won.0b013e3182750117] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
7
|
Le Breton F, Guinet A, Verollet D, Jousse M, Amarenco G. Therapeutic education and intermittent self-catheterization: recommendations for an educational program and a literature review. Ann Phys Rehabil Med 2012; 55:201-12. [PMID: 22424733 DOI: 10.1016/j.rehab.2012.01.006] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2011] [Revised: 01/25/2012] [Accepted: 01/28/2012] [Indexed: 11/19/2022]
Abstract
PURPOSE To review the literature and to clarify the recommendations for therapeutic education programs for intermittent self-catheterization. MATERIALS AND METHODS The literature on Medline, Pubmed, and Cochrane Library, with specific keywords, as well as the recommendations based on expert consensus. RESULTS Clean intermittent self-catheterization (CICS) is the gold standard for managing chronic urinary retention, which allows the patients to improve their quality of life and to reduce the complications of upper urinary tract infections. Patient education needs to have a structured procedure in order to evaluate the ability to understand, accept and perform CISC. CONCLUSION Teaching self-catheterization is now well known; nevertheless, the effectiveness of CISC educational therapeutic programs remains to be demonstrated.
Collapse
Affiliation(s)
- F Le Breton
- UR6/UPMC, service de neuro-urologie et d'explorations périnéales, hôpital Tenon, Paris cedex, France.
| | | | | | | | | |
Collapse
|
8
|
Singh R, Rohilla RK, Sangwan K, Siwach R, Magu NK, Sangwan SS. Bladder management methods and urological complications in spinal cord injury patients. Indian J Orthop 2011. [PMID: 21430869 DOI: 10.4103/0019-51413.77134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The optimal bladder management method should preserve renal function and minimize the risk of urinary tract complications. The present study is conducted to assess the overall incidence of urinary tract infections (UTI) and other urological complications in spinal cord injury patients (SCI), and to compare the incidence of these complications with different bladder management subgroups. MATERIALS AND METHODS 545 patients (386 males and 159 females) of traumatic spinal cord injury with the mean age of 35.4±16.2 years (range, 18 - 73 years) were included in the study. The data regarding demography, bladder type, method of bladder management, and urological complications, were recorded. Bladder management methods included indwelling catheterization in 224 cases, clean intermittent catheterization (CIC) in 180 cases, condom drainage in 45 cases, suprapubic cystostomy in 24 cases, reflex voiding in 32 cases, and normal voiding in 40 cases. We assessed the incidence of UTI and bacteriuria as the number of episodes per hundred person-days, and other urological complications as percentages. RESULTS The overall incidence of bacteriuria was 1.70 / hundred person-days. The overall incidenceof urinary tract infection was 0.64 / hundered person-days. The incidence of UTI per 100 person-days was 2.68 for indwelling catheterization, 0.34 for CIC, 0.34 for condom drainage, 0.56 for suprapubic cystostomy, 0.34 for reflex voiding, and 0.32 for normal voiding. Other urological complications recorded were urethral stricture (n=66, 12.1%), urethritis (n=78, 14.3%), periurethral abscess (n=45, 8.2%), epididymorchitis (n=44, 8.07%), urethral false passage (n=22, 4.03%), urethral fistula (n=11, 2%), lithiasis (n=23, 4.2%), hematuria (n=44, 8.07%), stress incontinence (n=60, 11%), and pyelonephritis (n=6, 1.1%). Clean intermittent catheterization was associated with lower incidence of urological complications, in comparison to indwelling catheterization. CONCLUSIONS Urinary tract complications largely appeared to be confined to the lower urinary tract. The incidence of UTI and other urological complications is lower in patients on CIC in comparison to the patients on indwelling catheterizations. Encouraging CIC; early recognition and treatment of the UTI and urological complications; and a regular follow up is necessary to reduce the medical morbidity.
Collapse
Affiliation(s)
- Roop Singh
- Department of Orthopedic Surgery, Paraplegia and Rehabilitation, Pt. B.D. Sharma PGIMS, Rohtak, Haryana, India
| | | | | | | | | | | |
Collapse
|
9
|
Ryu KH, Kim YB, Yang SO, Lee JK, Jung TY. Results of urine culture and antimicrobial sensitivity tests according to the voiding method over 10 years in patients with spinal cord injury. Korean J Urol 2011; 52:345-9. [PMID: 21687395 PMCID: PMC3106168 DOI: 10.4111/kju.2011.52.5.345] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2011] [Accepted: 04/25/2011] [Indexed: 11/23/2022] Open
Abstract
Purpose We studied the results of urine cultures and antimicrobial sensitivity tests according to the voiding method used by spinal cord injury (SCI) patients over a recent 10-year period. Materials and Methods We retrospectively analyzed 1,236 urine samples and their antimicrobial sensitivity tests for 112 patients who had used only one voiding method between January 2000 and December 2009. The voiding methods were classified into four groups: clean intermittent catheterization (CIC), suprapubic catheterization, urethral Foley catheter, and spontaneous voiding. Results Of the 1,236 urine samples, 925 (74.8%) were positive and 279 (30.2%) had more than one bacteria. The CIC group showed the lowest rate of bacteriuria, colony counts, and polymicrobial infection (p<0.001). Causative organisms were mostly Gram-negative bacteria (84%), including Pseudomonas aeruginosa (22.9%), Escherichia coli (21.1%), Klebsiella species (6.7%), and Citrobacter species (6.3%). The rate of Gram-positive bacterial infection was 13.6%, and major pathogenic organisms were Streptococcus species (8.6%) and Staphylococcus species (2.6%). Major pathogenic organisms and the results of antimicrobial sensitivity tests differed according to the voiding method. Conclusions Although the patient's condition and preferences are important when choosing the method of bladder management, CIC is the best voiding method for reducing urinary tract infections in SCI patients. When immediate use of antibiotics is needed for treatment of urinary tract infections, an appropriate antibiotic can be chosen according to the voiding method on the basis of our study and can be administered before the results of an antimicrobial sensitivity test are available.
Collapse
Affiliation(s)
- Kyoung Ho Ryu
- Department of Urology, Seoul Veterans Hospital, Seoul, Korea
| | | | | | | | | |
Collapse
|
10
|
Singh R, Rohilla RK, Sangwan K, Siwach R, Magu NK, Sangwan SS. Bladder management methods and urological complications in spinal cord injury patients. Indian J Orthop 2011; 45:141-7. [PMID: 21430869 PMCID: PMC3051121 DOI: 10.4103/0019-5413.77134] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND The optimal bladder management method should preserve renal function and minimize the risk of urinary tract complications. The present study is conducted to assess the overall incidence of urinary tract infections (UTI) and other urological complications in spinal cord injury patients (SCI), and to compare the incidence of these complications with different bladder management subgroups. MATERIALS AND METHODS 545 patients (386 males and 159 females) of traumatic spinal cord injury with the mean age of 35.4±16.2 years (range, 18 - 73 years) were included in the study. The data regarding demography, bladder type, method of bladder management, and urological complications, were recorded. Bladder management methods included indwelling catheterization in 224 cases, clean intermittent catheterization (CIC) in 180 cases, condom drainage in 45 cases, suprapubic cystostomy in 24 cases, reflex voiding in 32 cases, and normal voiding in 40 cases. We assessed the incidence of UTI and bacteriuria as the number of episodes per hundred person-days, and other urological complications as percentages. RESULTS The overall incidence of bacteriuria was 1.70 / hundred person-days. The overall incidenceof urinary tract infection was 0.64 / hundered person-days. The incidence of UTI per 100 person-days was 2.68 for indwelling catheterization, 0.34 for CIC, 0.34 for condom drainage, 0.56 for suprapubic cystostomy, 0.34 for reflex voiding, and 0.32 for normal voiding. Other urological complications recorded were urethral stricture (n=66, 12.1%), urethritis (n=78, 14.3%), periurethral abscess (n=45, 8.2%), epididymorchitis (n=44, 8.07%), urethral false passage (n=22, 4.03%), urethral fistula (n=11, 2%), lithiasis (n=23, 4.2%), hematuria (n=44, 8.07%), stress incontinence (n=60, 11%), and pyelonephritis (n=6, 1.1%). Clean intermittent catheterization was associated with lower incidence of urological complications, in comparison to indwelling catheterization. CONCLUSIONS Urinary tract complications largely appeared to be confined to the lower urinary tract. The incidence of UTI and other urological complications is lower in patients on CIC in comparison to the patients on indwelling catheterizations. Encouraging CIC; early recognition and treatment of the UTI and urological complications; and a regular follow up is necessary to reduce the medical morbidity.
Collapse
Affiliation(s)
- Roop Singh
- Department of Orthopedic Surgery, Paraplegia and Rehabilitation, Pt. B.D. Sharma PGIMS, Rohtak, Haryana, India,Address for correspondence: Dr. Roop Singh, 9-J/ 52, Medical Enclave, PGIMS, Rohtak - 124 001, Haryana, India. E-mail:
| | - Rajesh Kumar Rohilla
- Department of Orthopedic Surgery, Paraplegia and Rehabilitation, Pt. B.D. Sharma PGIMS, Rohtak, Haryana, India
| | - Kapil Sangwan
- Department of Orthopedic Surgery, Paraplegia and Rehabilitation, Pt. B.D. Sharma PGIMS, Rohtak, Haryana, India
| | - Ramchander Siwach
- Department of Orthopedic Surgery, Paraplegia and Rehabilitation, Pt. B.D. Sharma PGIMS, Rohtak, Haryana, India
| | - Narender Kumar Magu
- Department of Orthopedic Surgery, Paraplegia and Rehabilitation, Pt. B.D. Sharma PGIMS, Rohtak, Haryana, India
| | - Sukhbir Singh Sangwan
- Department of Orthopedic Surgery, Paraplegia and Rehabilitation, Pt. B.D. Sharma PGIMS, Rohtak, Haryana, India
| |
Collapse
|
11
|
Castel-Lacanal E, Gamé X, De Boissezon X, Guillotreau J, Bourg V, Clanet M, Roques CF, Marque P. Observance et impact sur la qualité de vie du cathétérisme intermittent chez les patients atteints de sclérose en plaques. ACTA ACUST UNITED AC 2009. [DOI: 10.1007/s11608-009-0225-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
12
|
Abstract
This article discusses all of the urethral diseases observed in patients with neurogenic bladder. The frequency of these disorders has decreased considerably with progress in intermittent catheterization and bladder retraining. However, urologists may occasionally be required to manage an urethral diverticulum, or an ulcer of the urethra over an indwelling catheter and must be familiar with the specific features in this setting.
Collapse
Affiliation(s)
- A Ruffion
- Service d'urologie Lyon Sud, Centre Hospitalier Lyon Sud, UCBL Lyon 1, France.
| | | |
Collapse
|
13
|
Walter JS, Sacks J, Othman R, Scianna J, Nemchausky B, Chintam R, Anfinsen L. Characteristics of persons with spinal cord injury as documented by use of an interactive data system. J Spinal Cord Med 2007; 23:257-62. [PMID: 17536295 DOI: 10.1080/10790268.2000.11753534] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
RATIONALE Physicians need information about their rehabilitation practices that shows the types of patients being seen and the outcomes for their rehabilitation programs. In order to obtain more information on secondary medical complications and prevention programs, and to provide the information to the spinal cord injury (SCI) rehabilitation team, an interactive data management system was developed. RESULTS Initial findings for the first 99 patients with SCI were presented for staff review. Demographic information indicated that patients typically lived in private residences, had at least a high school education, and had annual incomes < $20,000. There were nearly equal numbers of paraplegic and tetraplegic patients; 63% of patients were more than 50 years of age and 69% were more than 10 years post-injury. Over 80% of the patients reported satisfactory health, were physically active, and had adequate transportation. Paraplegic and tetraplegic patients had similar profiles for secondary complications. CONCLUSIONS The SCI staff was surprised that greater than 35% of patients with SCI reported current problems with spasticity, pain, and pressure ulcers. The staff was interested in obtaining additional patient-perception information including the severity of each problem, how the problem interfered with daily activity, and the desire for additional care. The staff felt that patients were reporting problems more often to the interviewer than to their physician. There was unanimous support for the ongoing collection of patient-perception information.
Collapse
Affiliation(s)
- J S Walter
- Rehabilitation Research and Development Section, Hines VA Hospital, Hines, Illinois 60141, USA
| | | | | | | | | | | | | |
Collapse
|
14
|
Ruffion A, Traxer O, Chartier-Kastler E. Chapitre A - Lithiase et vessie neurogène. Prog Urol 2007; 17:417-23. [PMID: 17622069 DOI: 10.1016/s1166-7087(07)92340-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Stones of the upper and lower urinary tract are frequently observed in spinal cord injury patients. In this article, the authors reviewed the literature to identify the most reliable tools for diagnosis and follow-up. A review of recently published series demonstrated an excess risk of kidney and bladder stones in this population. The authors discuss the possible measures of prevention and identification of high-risk groups likely to benefit from more intensive follow-up.
Collapse
Affiliation(s)
- A Ruffion
- Service d'urologie Lyon Sud, Centre Hospitalier Lyon Sud, UCBL Lyon 1, France.
| | | | | |
Collapse
|
15
|
C. Sondage. Prog Urol 2007. [DOI: 10.1016/s1166-7087(07)92357-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
16
|
Ruffion A, Villar E, Denys P, Chartier-Kastler E. Chapitre B - Insuffisance rénale et vessie neurologique. Prog Urol 2007; 17:424-30. [PMID: 17622070 DOI: 10.1016/s1166-7087(07)92341-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Historically, impaired renal function was the leading cause of death in spinal cord injury patients. Although the management of these patients has considerably improved due to progress in functional rehabilitation and neurourology, renal failure remains a significant cause of morbidity in this population. In this article, the authors review and classify the diagnostic tools able to detect urological changes likely to induce irreversible impairment of renal function. Based on a review of the recent literature, they define the incidence of renal impairment (morphological or function) in spinal cord injury patients and describe the main risk factors for deterioration of renal function in these patients.
Collapse
Affiliation(s)
- A Ruffion
- Service d'urologie Lyon Sud, Centre Hospitalier Lyon Sud, UCBL Lyon 1, France.
| | | | | | | |
Collapse
|
17
|
Paker N, Soy D, Kesiktaş N, Nur Bardak A, Erbil M, Ersoy S, Ylmaz H. Reasons for rehospitalization in patients with spinal cord injury: 5 years' experience. Int J Rehabil Res 2006; 29:71-6. [PMID: 16432393 DOI: 10.1097/01.mrr.0000185953.87304.2a] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The aim of this study was to determine the causes of rehospitalization in patients with spinal cord injury (SCI) treated in Istanbul Physical Medicine and Rehabilitation Centre and to compare the data with previous studies. Patients who were rehospitalized after an initial phase of rehabilitation between 1 January 1996 and 31 December 2001 were enrolled into the study. SCI patients aged 17 years or over at the time of injury were included. This retrospective study was designed using our medical records. In 5 years, 733 SCI patients were treated and 56 of them experienced rehospitalization. We examined the demographic and injury characteristics of rehospitalized patients with SCI. The SPSS computer programme was used for statistical analysis. We found that the rate of rehospitalization was 7.6%, the length of stay (LOS) was 72.21 days and the average age was 34.25 years. The reasons for rehospitalization were, in descending order, spasticity 25%, additional rehabilitation 21.4%, pressure sores 17.9%, urinary infection 16.1%, spinal surgery 8.9%, urinary system surgery 5.4% and pain 5.4%. Statistical significance was found between mean age and causes. The patients who were rehospitalized because of spinal surgery had a lower mean age than those rehospitalized because of pain (P=0.04, F=2.4). The most frequent reasons for rehospitalization of patients over 25 years old were spasticity and pressure sores. In conclusion, SCI patients' LOS was longer than found in previous studies because of a lack of efficient home rehabilitation. The most frequent cause of rehospitalization was spasticity, because of uncontrolled medical therapy. The study demonstrates how education of the patients and their families is important, and that home-based rehabilitation services must be established and supported by government.
Collapse
Affiliation(s)
- Nurdan Paker
- Istanbul Physical Medicine and Rehabilitation Training Hospital, 34590 Istanbul, Turkey
| | | | | | | | | | | | | |
Collapse
|
18
|
Ku JH, Jung TY, Lee JK, Park WH, Shim HB. Influence of bladder management on epididymo-orchitis in patients with spinal cord injury: clean intermittent catheterization is a risk factor for epididymo-orchitis. Spinal Cord 2005; 44:165-9. [PMID: 16151451 DOI: 10.1038/sj.sc.3101825] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
STUDY DESIGN Retrospective study, based on cases of spinal cord injury (SCI). OBJECTIVES To establish hazard ratios for risk of epididymo-orchitis in SCI. SETTING South Korea. METHODS A total of 140 male patients injured before 1987 were eligible for this investigation and have been followed up on a yearly basis from January 1987 to December 2003. RESULTS The average age at which the lesion occurred was 24.8 years old (range, 18-53). The average time since SCI was 16.9 years (range, 1-37). A total of 34 lesions (24.3%) were complete and 106 (75.7%) were incomplete. Over the 17 years, 39 patients (27.9%) were diagnosed with epididymo-orchitis. Epididymo-orchitis was more common for patients with a history of urethral stricture (66.7 versus 25.2%, P=0.014). We also found that epididymo-orchitis was more common for patients on clean intermittent catheterization (CIC) than with indwelling urethral catheterization (42.2% versus 8.3%, P=0.030). In multivariate analysis, patients on CIC had a 7.0-fold higher risk (odds ratio, 6.96; 95% confidence interval, 1.26-38.53; P=0.026); however, a history of urethral stricture lost statistical significance (P=0.074). For other variables, no positive association with epididymo-orchitis was observed. CONCLUSIONS In this study, CIC was an independent risk factor for the development of epididymo-orchitis in patients with SCI. In addition, our findings suggest that urethral stricture may be a contributing factor for the development of epididymo-orchitis in these patients. Correct instructions about CIC are of utmost importance.
Collapse
Affiliation(s)
- J H Ku
- Department of Urology, Seoul Veterans Hospital, Seoul, Republic of Korea
| | | | | | | | | |
Collapse
|
19
|
Manns PJ, McCubbin JA, Williams DP. Fitness, inflammation, and the metabolic syndrome in men with paraplegia. Arch Phys Med Rehabil 2005; 86:1176-81. [PMID: 15954057 DOI: 10.1016/j.apmr.2004.11.020] [Citation(s) in RCA: 133] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To determine the relations among peak aerobic capacity, physical activity, functional ability, components of the metabolic syndrome (high-density lipoprotein cholesterol [HDL-C], triglycerides [TG], glucose, insulin, abdominal obesity, high blood pressure), and inflammatory factors (interleukin-6 [IL-6], C-reactive protein [CRP]) in men with paraplegia. DESIGN Cross-sectional exploratory design. SETTING University research laboratory. PARTICIPANTS Twenty-two men (age, 39+/-9y; duration of injury, 17+/-9y; level of injury, T2-L2) with functionally complete paraplegia volunteered to participate. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Peak aerobic capacity was measured using a graded peak exercise test with an arm ergometer, and physical activity was assessed by the Physical Activity and Disability Scale. Functional ability was assessed by the Self-Report Functional Measure. Circulating glucose, insulin, HDL-C, TG, total cholesterol, IL-6, and CRP levels were determined by specific enzyme or immunologic assays. Body fat was determined by dual-energy x-ray absorptiometry, and central obesity was estimated from abdominal sagittal diameters. RESULTS Lower peak aerobic capacities were associated with lower HDL-C and lower physical activity levels ( P <.014). Lower physical activity levels were associated with higher fasting glucose, lower HDL-C level, and larger abdominal sagittal diameters ( P <.036). Larger abdominal sagittal diameters were associated with higher fasting glucose, higher fasting and postload insulin, lower HDL-C, higher TG, and higher CRP levels ( P <.05). CONCLUSIONS Diet and exercise trials are needed to determine the efficacy and effectiveness of lifestyle interventions aimed at slowing the progression of the metabolic syndrome in people with spinal cord injury.
Collapse
Affiliation(s)
- Patricia J Manns
- College of Health and Human Sciences, Department of Exercise and Sport Science, Oregon State University, Corvallis, OR, USA.
| | | | | |
Collapse
|
20
|
Mizuno K, Tsuji T, Kimura A, Liu M, Masakado Y, Chino N. Twenty-seven years of complication-free life with clean intermittent self-catheterization in a patient with spinal cord injury: A case report. Arch Phys Med Rehabil 2004; 85:1705-7. [PMID: 15468034 DOI: 10.1016/j.apmr.2004.03.030] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Currently, clean intermittent self-catheterization (CISC) is the most prevalent method of bladder management in patients with spinal cord injury (SCI) at discharge from rehabilitation centers. However, half of the patients discontinue using CISC and change to other methods of bladder management several months postdischarge despite the fact that it the best way to prevent urinary tract complications. Few studies, however, report the long-term consequences of CISC. In this case, we present a woman in her early fifties who had sustained thoracic SCI and had continued using CISC for 27 years without developing any complications. The possible reasons for her success were absence of incontinence because of underactive and normal capacity bladder; normal upper-extremity functions and absence of marked spasticity of lower extremities that facilitated CISC technique; and absence of sociovocational problems, enabling her to keep proper intervals between catheterizations each day. This case indicates that CISC is useful for long-term bladder management in patients with SCI, even for 25 years or more. Long-term outcomes of CISC and factors leading to success need to be delineated in future studies with larger samples.
Collapse
Affiliation(s)
- Katsuhiro Mizuno
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan.
| | | | | | | | | | | |
Collapse
|
21
|
Hansen RB, Biering-Sørensen F, Kristensen JK. Bladder emptying over a period of 10–45 years after a traumatic spinal cord injury. Spinal Cord 2004; 42:631-7. [PMID: 15326470 DOI: 10.1038/sj.sc.3101637] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Epidemiological follow-up study. OBJECTIVE To examine the bladder-emptying methods at least 10 years after a traumatic spinal cord injury (SCI). SETTING Clinic for Para- and Tetraplegia and Department of Urology, Rigshospitalet, Copenhagen University Hospital, Denmark. METHODS Retrospective data collection from patient records and data collected with a follow-up questionnaire. The response rate was 84.6% corresponding to 236 SCI individuals, injured in 1956-1990. There were 82/18% male/female patients and 47/53% tetraplegic/paraplegic. Age at the time of follow-up was 50.5 years in mean (range 28-84). Years from time of injury were 24.1 years in mean (range 10-45). RESULTS The use of clean intermittent catheterisation (CIC) rose from 11% at the initial discharge to 36% at the time of follow-up. The use of suprapubic tapping fell from 57 to 31% in the same period, while the use of Crede manoeuvre rose from 5 to 19%. During follow-up, 46% changed bladder-emptying method. The results showed the following trends in change of method: a high proportion of discontinuation in normal bladder emptying, suprapubic tapping and abdominal pressure and a high proportion of continuation when using CIC. 28% found their bladder-emptying method to be a problem; of these 58% were tetraplegic. Of the participants using CIC, 92% reported using hydrophilic-coated catheters. CONCLUSIONS Changing of bladder-emptying method among SCI individuals over time is common. CIC alone or in combination with another bladder-emptying method is the most frequently used method of bladder emptying. SPONSORSHIP The study was carried out as part of the primary author's PhD-study, which was financed by Medicon Valley Academy and Coloplast A/S.
Collapse
Affiliation(s)
- R B Hansen
- Clinic for Para- and Tetraplegia, Rigshospitalet, Copenhagen University Hospital, Denmark
| | | | | |
Collapse
|
22
|
de Sèze M, Shao É, Joseph P. Infections urinaires nosocomiales en médecine physique et réadaptation : particularités des vessies neurologiques. Med Mal Infect 2003. [DOI: 10.1016/s0399-077x(03)00175-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
23
|
Biering-Sørensen F, Bagi P, Høiby N. Urinary tract infections in patients with spinal cord lesions: treatment and prevention. Drugs 2002; 61:1275-87. [PMID: 11511022 DOI: 10.2165/00003495-200161090-00004] [Citation(s) in RCA: 76] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Even though the mortality due to urinary tract complications has decreased dramatically during the last decades in individuals with spinal cord lesions (SCL), urinary tract infections (UTI) still cause significant morbidity in this population. Complicated UTI are caused by a much wider variety of organisms in individuals with SCL than in the general population and are often polymicrobial. Escherichia coli, Pseudomonas spp., Klebsiella spp., Proteus spp., Serratia spp., Providencia spp., enterococci, and staphylococci are the most frequently isolated bacteria in urine specimens taken from individuals with SCL. There is no doubt that the greatest risk for complicated UTI in these individuals is the use of an indwelling catheter. Intermittent catheterisation during the rehabilitation phase has been shown to lower the rate of UTI, and virtually eliminate many of the complications associated with indwelling catheters. Persons with SCL should only be treated for bacteriuria if they have symptoms. Generally, it is advisable to use antibacterial agents with little or no impact on the normal flora. Single agent therapy - in accordance with antimicrobial susceptibility test - is preferred. We advise extending treatment to at least 5 days, and in those with reinfection or relapsing UTI, at least 7 to 14 days, depending on the severity of the infection. The diagnosis of structural and/or functional risk factors is essential in order to plan an optimal treatment for UTI in individuals with SCL, which should include treatment of simultaneously occurring predisposing factors. The treatment of structural risk factors follows general urological principles, aiming for sufficient outlet from the bladder with minimal residual urine and low pressure voiding. For prevention of UTI, general cleanliness and local hygiene should be encouraged. If the patient has a reinfection or relapsing symptomatic UTI, it is important to check for inadequately treated infection and complications, which need special attention, in particular residual urine and urinary stones. No reliable evidence exists of the effectiveness of cranberry juice and other cranberry products. Prophylactic antibacterials should only be used in patients with recurrent UTI where no underlying cause can be found and managed, and in particular if the upper urinary tract is dilated. Antibacterials should not be used for the prevention of UTI in individuals with SCL and indwelling catheters. However, the use of prophylactic antibacterials for individuals with SCL using intermittent catheterisation or other methods of bladder emptying is controversial.
Collapse
Affiliation(s)
- F Biering-Sørensen
- Clinic for Para- and Tetraplegia, Copenhagen University Hospital, Rigshospitalet, Denmark.
| | | | | |
Collapse
|
24
|
Cox RJ, Amsters DI, Pershouse KJ. The need for a multidisciplinary outreach service for people with spinal cord injury living in the community. Clin Rehabil 2001; 15:600-6. [PMID: 11777090 DOI: 10.1191/0269215501cr453oa] [Citation(s) in RCA: 85] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To identify the nature and extent of perceived unmet needs of people with spinal cord injury (SCI) living in the community and to determine their preferences regarding multidisciplinary outreach service delivery. DESIGN Structured telephone interviews. SETTING Spinal Injuries Unit, Queensland, Australia. SUBJECTS Sixty people with SCI living in the community were approached for interview and 54 agreed to participate. RESULTS The results reflected a high need for a specialist, multidisciplinary SCI outreach service following primary rehabilitation. There were a diversity of issues faced by people with SCI. A high or very high need was reported by 31% of participants in relation to physical changes, by 24% regarding transport, by 22% for work issues and by 19% with respect to ongoing education needs. The greatest perceived barrier to needs being met was limited local specialist knowledge about SCI (81% of participants). A service model which includes access to telephone advice was endorsed by 79% of participants, and 43% supported home visiting that is available to rural and remote areas. Spinal Injuries Unit outpatient clinic appointments were also a preference for service delivery (40% of participants). CONCLUSIONS Trial and evaluation of the telephone as a primary medium for service delivery, and education of local service providers is recommended.
Collapse
Affiliation(s)
- R J Cox
- Spinal Outreach Team, Buranda, Brisbane, Australia.
| | | | | |
Collapse
|
25
|
Jamil F. Towards a catheter free status in neurogenic bladder dysfunction: a review of bladder management options in spinal cord injury (SCI). Spinal Cord 2001; 39:355-61. [PMID: 11464308 DOI: 10.1038/sj.sc.3101132] [Citation(s) in RCA: 67] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
STUDY DESIGN Review. OBJECTIVES To assess current available options for bladder management in SCI patients the post-acute phase. METHODS Relevant articles were extracted from medline and Cinahl between 1966--1999. In addition, references earlier than 1966 that were listed in these articles were identified and extracted. RESULTS Catheterisation (indwelling or self intermittent) is still carried out by the majority of SCI patients with more morbidity for indwelling catheterisation. Other methods include condom drainage, suprapubic tapping and supreapubic pressure are used and are associated with less complications. Complicated procedures like sacral anterior root stimulator and entero-cystoplasty are carried out with the onset of or impending complications. CONCLUSION Several methods of bladder management are available in the post-acute phase of SCI. The method used has to be based on urodynamic characteristics with the aim of producing a continent bladder with adequate low pressure storage capacity. Modern management of the bladder in SCI has successfully reduced renal related mortality in SCI from 95% in the first half of the 20th century to the present 3%.
Collapse
Affiliation(s)
- F Jamil
- Duke of Cornwall Spinal Treatment Centre, Salisbury, Wiltshire
| |
Collapse
|
26
|
INTERMITTENT CATHETERIZATION WITH A PRELUBRICATED CATHETER IN SPINAL CORD INJURED PATIENTS: A PROSPECTIVE RANDOMIZED CROSSOVER STUDY. J Urol 2001. [DOI: 10.1097/00005392-200107000-00030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
27
|
GIANNANTONI ANTONELLA, DI STASI SAVINOM, SCIVOLETTO GIORGIO, VIRGILI GUIDO, DOLCI SUSANNA, PORENA MASSIMO. INTERMITTENT CATHETERIZATION WITH A PRELUBRICATED CATHETER IN SPINAL CORD INJURED PATIENTS: A PROSPECTIVE RANDOMIZED CROSSOVER STUDY. J Urol 2001. [DOI: 10.1016/s0022-5347(05)66092-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- ANTONELLA GIANNANTONI
- From the Department of Urology, University of Perugia, Policlinico Monteluce, Perugia and Departments of Urology and Cellular Biology, “Tor Vergata” University of Rome and S. Lucia Rehabilitation Hospital, Rome, Italy
| | - SAVINO M. DI STASI
- From the Department of Urology, University of Perugia, Policlinico Monteluce, Perugia and Departments of Urology and Cellular Biology, “Tor Vergata” University of Rome and S. Lucia Rehabilitation Hospital, Rome, Italy
| | - GIORGIO SCIVOLETTO
- From the Department of Urology, University of Perugia, Policlinico Monteluce, Perugia and Departments of Urology and Cellular Biology, “Tor Vergata” University of Rome and S. Lucia Rehabilitation Hospital, Rome, Italy
| | - GUIDO VIRGILI
- From the Department of Urology, University of Perugia, Policlinico Monteluce, Perugia and Departments of Urology and Cellular Biology, “Tor Vergata” University of Rome and S. Lucia Rehabilitation Hospital, Rome, Italy
| | - SUSANNA DOLCI
- From the Department of Urology, University of Perugia, Policlinico Monteluce, Perugia and Departments of Urology and Cellular Biology, “Tor Vergata” University of Rome and S. Lucia Rehabilitation Hospital, Rome, Italy
| | - MASSIMO PORENA
- From the Department of Urology, University of Perugia, Policlinico Monteluce, Perugia and Departments of Urology and Cellular Biology, “Tor Vergata” University of Rome and S. Lucia Rehabilitation Hospital, Rome, Italy
| |
Collapse
|