Non‐operative management of the urinary tract in spinal cord injury

Abstract

Various options exist for the management of the lower urinary tract in chronic spinal cord injury. These options include chronic indwelling catheterization, urethral sphincterotomy, and intermittent catheterization supplemented with anticholinergic agents. Sixty-four spinal cord injured patients, treated with intermittent catheterization and anticholinergic therapy, were evaluated for long-term efficacy in maintaining upper tract status and preservation or improvement in continence. Complications of therapy were also evaluated. Therapy was based upon initial urodynamic evaluation followed by limited subsequent evaluation of the urinary tract. Mean follow-up was 54 months. Only 1 patient developed hydronephrosis. Fifty-nine patients either became continent or experienced improved continence on therapy. Eight patients required surgical procedures either to increase outlet resistance (2) or to decrease intravesical pressures (6). The most common complication of therapy was urinary tract infection. Thirty-nine infections occurred in 23 patients, 16 of which were febrile. Fifteen patients were non-compliant with treatment recommendations. The only factor related to therapeutic complications which reached statistical significance was non-compliance with therapy. The combined use of intermittent catheterization and anticholinergic agents provides an effective means to prevent hydronephrosis and establish continence in chronic spinal injury.

The Therapeutic Effects and Pathophysiology of Botulinum Toxin A on Voiding Dysfunction Due to Urethral Sphincter Dysfunction

“…While detrusor sphincter dyssynergia (DSD) commonly stands for the well-known neurogenic cause [2], dysfunctional voiding (DV), Fowler's syndrome (FS), and poor relaxation of the external urethral sphincter (PRES) during voiding comprise the have been used to decrease outlet resistance, but the results of urodynamic studies have not been convincing [35]. Clean intermittent catheterization (CIC) is an effective alternative for patients to empty their bladder, but some patients are not able to tolerate it well due to upper limb impairment or psychological unwillingness [36]. Surgical sphincterotomy is another drastic option for those who fail in the treatments mentioned above, however, many of such patients experience a worsened quality of life due to persistent incontinence and a high long-term failure rate [37].…”

Botulinum A toxin treatment for detrusor-sphincter dyssynergia in spinal cord disease

“…ISC may also be poorly tolerated locally (hematuria, urethral stricture) or psychologically. 2 Sphincterotomy is e ective but permanent incontinence may be induced and a high reoperation rate and long term failure has been described. 3,4 Sacral anterior root stimulators and posterior rhizotomy are mainly indicated for patients with complete neural de®cits.…”

Managing the urinary tract in spinal cord injury

“…[14] Oral therapy is generally used as first line treatment for the patient who is incontinent while on CISC as a result of neurogenic detrusor overactivity. However, when oral treatment is not proving effective, a trial of intravesical oxybutynin can be undertaken as this may provide additional benefit in some cases.…”