Voiding by increased abdominal pressure in male spinal cord injury patients – long term follow up

Greenstein, A.; Rucker, Karen S.; Katz, P. Gary

doi:10.1038/sc.1992.64

Cited by 7 publications

(9 citation statements)

References 6 publications

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“…By comparison, detrusor overactivity and detrusor‐sphincter dyssynergia occurs in 95% and 68% of suprasacral spinal‐injured human patients, respectively . These functional changes during urine storage and voiding can lead to complications, such as vesicoureteral reflux and secondary pressure‐induced upper urinary tract injury, as well as increased risks for urinary tract infection …”

Section: Clinical Consequencesmentioning

confidence: 99%

“…In addition to infection‐induced morbidity and mortality, neurogenic outflow obstruction, and intravesical pressure elevation after spinal cord injury can lead to vesicoureteral reflux and subsequent upper urinary tract anatomic and functional deterioration. Vesicoureteral reflux is particularly common in human patients after complete upper motor neuron spinal cord injuries . Injuries at T10–L2, where the sympathetic intermediolateral nuclei that mediate sphincter relaxation during voiding are located, are associated with the highest incidence of vesicoureteral reflux …”

Section: Clinical Consequencesmentioning

confidence: 99%

“…35 These functional changes during urine storage and voiding can lead to complications, such as vesicoureteral reflux and secondary pressure-induced upper urinary tract injury, as well as increased risks for urinary tract infection. 4,[40][41][42][43][44] Normally, the mechanisms of continuous slow urine inflow from the upper urinary tract during bladder filling and intermittent rapid outflow during voiding prevent bacterial ascension, adhesion, and colonization within the lower urinary tract. 45 Urinary tract infections are more prevalent among spinal-injured individuals that lack the ability to clear bacteriuria efficiently because of infrequent bladder voiding, high residual volume, and the increased exposure to uropathogens that largely results from frequent urinary catheterization.…”

Section: Clinical Consequencesmentioning

confidence: 99%

“…Vesicoureteral reflux is particularly common in human patients after complete upper motor neuron spinal cord injuries. [41][42][43][44] Injuries at T10-L2, where the sympathetic intermediolateral nuclei that mediate sphincter relaxation during voiding are located, are associated with the highest incidence of vesicoureteral reflux. 54 In human patients, vesicoureteral reflux has been implicated in renal scarring identified on ultrasound examination, proteinuria, reduced glomerular filtration rate, elevated serum creatinine, reduced creatinine clearance rate, and hypertension.…”

Section: Clinical Consequencesmentioning

confidence: 99%

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Pathophysiology, Clinical Importance, and Management of Neurogenic Lower Urinary Tract Dysfunction Caused by Suprasacral Spinal Cord Injury

Granger

Jeffery

2016

Veterinary Internal Medicne

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Management of persistent lower urinary tract dysfunction resulting from severe thoracolumbar spinal cord injury can be challenging. Severe suprasacral spinal cord injury releases the spinal cord segmental micturition reflex from supraspinal modulation and increases nerve growth factor concentration in the bladder wall, lumbosacral spinal cord, and dorsal root ganglion, which subsequently activates hypermechanosensitive C‐fiber bladder wall afferents. Hyperexcitability of bladder afferents and detrusor overactivity can cause urine leaking during the storage phase. During urine voiding, the loss of supraspinal control that normally coordinates detrusor contraction with sphincter relaxation can lead to spinal cord segmental reflex‐mediated simultaneous detrusor and sphincter contractions or detrusor‐sphincter dyssynergia, resulting in inefficient urine voiding and high residual volume. These disease‐associated changes can impact on the quality of life and life expectancy of spinal‐injured animals. Here, we discuss the pathophysiology and management considerations of lower urinary tract dysfunction as the result of severe, acute, suprasacral spinal cord injury. In addition, drawing from experimental, preclinical, and clinical medicine, we introduce some treatment options for neurogenic lower urinary tract dysfunction that are designed to: (1) prevent urine leakage arising because of detrusor overactivity during bladder filling, (2) preserve upper urinary tract integrity and function by reducing intravesical pressure and subsequent vesicoureteral reflux, and (3) prevent urinary tract and systemic complications by treating and preventing urinary tract infections.

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Section: Clinical Consequencesmentioning

confidence: 99%

Section: Clinical Consequencesmentioning

confidence: 99%

Section: Clinical Consequencesmentioning

confidence: 99%

Section: Clinical Consequencesmentioning

confidence: 99%

See 2 more Smart Citations

Pathophysiology, Clinical Importance, and Management of Neurogenic Lower Urinary Tract Dysfunction Caused by Suprasacral Spinal Cord Injury

Granger

Jeffery

2016

Veterinary Internal Medicne

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“…Spinal cord injury patients, who empty their bladder by increased abdominal pressure either by Valsalva or by Crede manoeuvres, are at risk for developing vesicoureteral reflux and hydronephrosis [1]. Lamid [2] noticed that the incidence of reflux was statistically higher in patients with complete spinal lesion than in those with incomplete neurological dysfunction; the incidence was also higher in individuals with an upper motor neuron lesion.…”

Section: Introductionmentioning

confidence: 99%

Fatal Renal Failure in a Spinal Cord Injury Patient with Vesicoureteric Reflux Who Underwent Repeated Ureteric Reimplantations Unsuccessfully: Treatment Should Focus on Abolition of High Intravesical Pressures rather than Surgical Correction of Reflux

Vaidyanathan

Soni²,

Abraham³

et al. 2012

Case Reports in Urology

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A 29-year-old man developed paraplegia at T-10 level due to road traffic accident in 1972. Both kidneys were normal and showed good function on intravenous urography. Division of external urethral sphincter was performed in 1973. In 1974, cystogram showed retrograde filling of left renal tract, which was hydronephrotic. Left ureteric reimplantation was performed. Following surgery, cystogram revealed marked retrograde filling of left renal tract as before. Penile sheath drainage was continued. In 1981, intravenous urography revealed bilateral severe hydronephrosis. Left ureteric reimplantation was performed again in 1983. Blood pressure was 220/140 mm Hg; this patient was prescribed atenolol. Cystogram showed gross left vesicoureteral reflux. Intermittent catheterisation was commenced in 2001. In 2007, proteinuria was 860 mg/day. This patient developed progressive renal failure and expired in 2012. In a spinal cord injury patient with vesicoureteral reflux, the treatment should focus on abolition of high intravesical pressures rather than surgical correction of vesicoureteric reflux. Detrusor hyperactivity and high intravesical pressures are the basic causes for vesicoureteral reflux in spinal cord injury patients. Therefore, it is important to manage spinal cord injury patients with neuropathic bladder by intermittent catheterisations along with antimuscarinic drug therapy in order to abolish high detrusor pressures and prevent vesicoureteral reflux. Angiotensin-converting enzyme inhibitors or angiotensin-receptor-blocking agents should be prescribed even in the absence of hypertension when a spinal cord injury patient develops vesicoureteral reflux and proteinuria.

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Incidence of Renal Tract Abnormalities on Ultrasonography in Patients with Spinal Cord Injury: A Retrospective Pilot Study of a Military Cohort Undergoing Long-Term Institutional Rehabilitation

Saini¹,

Kataruka²,

Gogoi³

et al. 2022

Asian Spine J

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To assess the incidence of renal tract abnormalities using ultrasonography (US) in a military cohort with traumatic spinal cord injury (TSCI) at a tertiary level spinal cord injury center. Overview of Literature: Neurogenic bladder in TSCI patients results in significant urological morbidity. There is lack of data for these patients during the first 18 months of long-term rehabilitation in an institutional setting. Methods: We retrospectively reviewed patient records to collect data on demographic characteristics, injury level, injury severity, time since injury, bladder management methods (such as an indwelling catheter [IC], clean intermittent catheterization [CIC], or selfvoiding [S]); we correlated these data with the findings of the renal tract US. Results:The study included 73 out of 81 male participants. The mean patient age was 29.99 years; the study group included 34.2% tetraplegics and 65.8% people with paraplegia. The time since injury was 6-12 months for 42.5% of the subjects and 12-18 months for 57.5% of the subjects. A normal US scan was recorded in 65.7% patients, and bladder trabeculation was the commonest finding in 15.1% of the subjects, followed by hydronephrosis (HDN) in 12.3%, and renal calculus and atrophy in 1.3% participants each. We found 22.22% of the IC group participants had higher US abnormalities than those in the reflex voiding group (statistically nonsignificant difference, p=0.7). Trabeculations (21.4%) and HDN (19%) were more common in those who had sustained the injury 12-18 months previously as compared to that in those who had injured themselves 6-12 months previously (p=0.04). The proportion of patients who had a normal US scan was higher in the group who sustained the injury 6-12 months previously versus those who had sustained the injury 12-18 months previously; the difference was statistically significant (p=0.02). There was no significant (p=0.72) correlation in the bladder management method, injury level, and renal tract abnormalities between the groups. Conclusions: This retrospective study shows that 65% of TSCI participants had no renal tract abnormality on US scan and bladder trabeculation ruled out as the most common finding. Long-term supervised rehabilitation may help achieve good renal quality of life; however, further prospective trials are required on this subject.

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Voiding by increased abdominal pressure in male spinal cord injury patients – long term follow up

Cited by 7 publications

References 6 publications

Pathophysiology, Clinical Importance, and Management of Neurogenic Lower Urinary Tract Dysfunction Caused by Suprasacral Spinal Cord Injury

Pathophysiology, Clinical Importance, and Management of Neurogenic Lower Urinary Tract Dysfunction Caused by Suprasacral Spinal Cord Injury

Fatal Renal Failure in a Spinal Cord Injury Patient with Vesicoureteric Reflux Who Underwent Repeated Ureteric Reimplantations Unsuccessfully: Treatment Should Focus on Abolition of High Intravesical Pressures rather than Surgical Correction of Reflux

Incidence of Renal Tract Abnormalities on Ultrasonography in Patients with Spinal Cord Injury: A Retrospective Pilot Study of a Military Cohort Undergoing Long-Term Institutional Rehabilitation

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