No abstract

Introduction: Neurogenic bowel dysfunction resulting from spinal cord injury (SCI) frequently requires bowel care (BC) with stimulant suppositories for initiation of e ective defecation. The excessive time required for BC and bowel complications have limited quality of life after SCI. Objective: To test the hypothesis that: the time required for bowel care with bisacodyl suppositories can be reduced by substituting a polyethylene glycol base (PGB) for the traditional hydrogenated vegetable oil base (HVB) in the suppository. Setting: Inpatient SCI medicine unit. Subjects: Fourteen persons with SCI with chronic stable paralysis from upper motor neuron SCI for greater than one year with a stable HVB bisacodyl suppository initiated BC. Design: Crossover Controlled. Method: Subjects received HVB bisacodyl suppositories for six sequential BC sessions and then were crossed over to PGB bisacodyl suppositories for six more BCs. Outcome measures: BC event times were utilized to derive BC intervals: suppository insertion to ®rst¯atus=Time to¯atus, ®rst¯atus until the beginning of stool¯ow=Flatus to stool¯ow, begin stool¯ow until end stool¯ow=Defecation period, end stool¯ow until end of clean up=Clean up, and suppository insertion until end clean up=Total bowel care time. Results: The data included two groups of BC sessions: HVB (n=84) and PGB (n=81). Mean times in minutes and P values from t tests for paired samples yielded: Time to¯atus: (HVB 31, PGB 12.8 P50.002), Defecation period: (HVB 58, PGB 32, P50.0005), Clean up: (HVB 1.9, PGB 3.2 P=0.165), Total bowel care time: (HVB 102, PGB 51.2 P50.0005). Conclusion: This analysis suggests that PGB based bisacodyl suppositories may stimulate re¯ex defecation sooner and shorten the Total BC Time as compared with HVB bisacodyl suppositories.

The UroLume stent demonstrates long-term safety and efficacy for the treatment of external detrusor-sphincter dyssynergia. The outcome was similar in men with and without previous sphincterotomy.

While there is a potential for urethral injury and bleeding, UroLume endoprosthesis removal is largely a simple procedure with minimal complications and consequences.