Hydronephrosis and renal failure following inadequate management of neuropathic bladder in a patient with spinal cord injury: Case report of a preventable complication

Abstract

BackgroundCondom catheters are indicated in spinal cord injury patients in whom intravesical pressures during storage and voiding are safe. Unmonitored use of penile sheath drainage can lead to serious complications.Case reportA 32-year old, male person, sustained complete paraplegia at T-11 level in 1985. He had been using condom catheter. Eleven years after sustaining spinal injury, intravenous urography showed no radio-opaque calculus, normal appearances of kidneys, ureters and bladder. Blood urea and Creatinine were within reference range. A year later, urodynamics revealed detrusor pressure of 100 cm water when detrusor contraction was initiated by suprapubic tapping. This patient was advised intermittent catheterisation and take anti-cholinergic drug orally; but, he wished to continue penile sheath drainage. Nine years later, this patient developed bilateral hydronephrosis and renal failure. Indwelling urethral catheter drainage was established. Five months later, ultrasound examination of urinary tract revealed normal kidneys with no evidence of hydronephrosis.ConclusionSpinal cord injury patients with high intravesical pressure should not have penile sheath drainage as these patients are at risk for developing hydronephrosis and renal failure. Intermittent catheterisation along with antimuscarinic drug should be the preferred option for managing neuropathic bladder.

Nefrectomía asociada con renomegalia derecha en un perro afectado por hidronefrosis

“…Ao se inspecionar a renomegalia direita repleta de conteúdo líquido era esperado encontrar obstrução no trato urinário capaz de promover o acúmulo de líquido no rim, característico da fisiopatologia de hidronefrose e pionefrose (Choi et al, 2010;Vaidyanathan et al, 2012). Entretanto, nada foi observado macroscopicamente, não sendo observadas massas, urólitos, sinais de trauma ou cirurgia prévia.…”

“…Tipicamente essa bolsa é formada pela pressão exercida no tecido renal pelo líquido contido na pelve do órgão, comprometendo a sua integridade e causando atrofia compressiva do parênquima (Newman et al, 2011). Vaidyanathan et al (2012) e Santarosa et al (2007) relatam ainda o uso do ultrassom como ferramenta para o diagnóstico dessa patologia, descrevendo as características morfológicas e de ecogenicidade. Ressalta-se, todavia, que o diagnóstico poderia ser realizado por técnicas de radiografia para avaliação de urólitos, pielografia anterógrada (Raposo et al, 2013) ou por urografia excretora para verificação de anomalias em pelve e ureter (Slatter, 1998).…”

“…A hidronefrose decorre de obstrução total ou parcial do trato urinário inferior, o que promove dilatação progressiva da pelve renal e, por consequência, compressão e atrofia do parênquima renal (Şahal et al, 2005). As causas de obstruções são variadas, a citar: urolitíases, ureter ectópico, trauma, hérnia perineal, pielonefrite recorrente e complicações cirúrgicas (Choi et al, 2010;Vaidyanathan et al, 2012), neoplasias na uretra e próstata, obstrução por inflamação no trato urinário inferior, massas extrínsecas e ligadura cirúrgica acidental de ureter (Dibartola & Westropp, 2015;Kealy, 2012;Vac, 2004).…”

Male External Catheter in Adults: a glance at nursing care practice

“…Regarding the relative contraindications, we highlight the problems related to skin integrity or cognitive-behavioral alterations that make it difficult to maintain the MECA (5) . In chronic urinary retention due to detrusor hypoactivity or in retention with high urinary pressure, MECA is absolutely contraindicated if it is thought as a single strategy to control urinary dysfunction, in these cases, urethral catheterization is the option to choose because of the risk of involvement of the renal function (6)(7) .…”