Selecting the appropriate urinary diversion procedure in the spinal cord injured: a poignant reminder

Neurogenic bladder in spinal cord injury

In the past, renal failure was the leading cause of death after spinal cord injury (SCI). Today mortality from SCI has declined dramatically partly owing to the improved management of urologic dysfunction associated with SCI. The goals of bladder management in spinal cord injury patients are intended to (1) ensure social continence for reintegration into community, (2) allow low-pressure storage and efficient bladder emptying at low detrusor pressures, (3) avoid stretch injury from repeated overdistension, (4) prevent upper and lower urinary tracts complications from high intravesical pressures, and (5) prevent recurrent urinary tract infections. This article provides an overview of neurogenic bladder dysfunction associated with SCI and current management options.

Continent lower urinary tract reconstruction in the cervical spinal cord injured population

PURPOSE

Patients with cervical spinal cord injury and upper extremity dysfunction are treated primarily with indwelling or condom catheters. We present our experience with a select group of patients with limited upper extremity function to determine long-term success and patient satisfaction after lower urinary tract reconstruction.

MATERIALS AND METHODS

Between May 1988 and November 1996, 28 patients with cervical spinal cord injury underwent lower urinary tract reconstruction. Postoperative information was obtained on 21 patients. Charts were reviewed and patients were contacted by an independent reviewer to ascertain patient satisfaction and quality of life. Patient age was 17 to 51 years (average 34.6). Reconstructive procedures requiring catheterization included augmentation ileocystoplasty in 4 patients plus Mitrofanoff appendicovesicostomy in 7, a Kock ileal reservoir in 8 and an Indiana pouch in 2.

RESULTS

Catheterization was regularly performed by 20 of the 21 patients (95%). A total of 12 patients (60%) performed self-intermittent catheterization and 8 (40%) relied on an attendant or family member. Of the patients 80% reported improved quality of life since reconstruction, citing such reasons as lack of a need for urinary drainage bags, increased freedom and an improved sense of body image. Using a visual analog scale to grade satisfaction from 1 to 10 (1-extremely unsatisfied to 10-extremely satisfied) 14 patients (67%) reported a score of 8 or more.

CONCLUSIONS

With appropriate preoperative selection of the cervical spinal cord injured patient intermittent catheterization is successfully maintained in the long term, allowing greater flexibility in choice, and a resultant high level of patient satisfaction and improved quality of life.