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PubMed1984

Management of neurogenic bladder in female spinal cord injury patients.

Twenty-two female spinal cord injury patients were admitted to the Spinal Cord Injury Service at the West Roxbury VAMC during a period of 17 years (1965-1982). Bladder status and means of drainage were evaluated. Twelve patients (55%) required no means of drainage, nine of them were dry all the time, while the other three needed pamper support to counteract occasional wetness. Seven were on constant indwelling catheters, two were on self-catheterization, while one had an intestinal loop diversion. It appears that female spinal cord injury patients depend more on constant indwelling catheters than their male counterparts. In some instances, female paraplegics do well on self-catheterization. Catheter complications in female spinal cord injury patients appear to be less than in males.

Adolescent↗
PubMed1998

Does refrigeration of urine alter culture results in hospitalized patients with neurogenic bladders?

A prospective, blinded study of 40 hospitalized spinal cord injured (SCI) patients was conducted to evaluate the effects of refrigeration on urinalysis and culture results. Urine samples were divided, with one aliquot examined within 4 hours and the other after 24 hours of refrigeration. Comparisons using Wilcoxon Signed Rank analysis showed no significant difference between fresh and refrigerated samples in white blood cell (WBC) count (z = -0.353, p = 0.724), number of bacteria (z = -0.772, p = 0.440), leukocytes (z = -0.277, p = 0.782), or colony counts of E. fecalis, E. coli, Citrobacter, Pseudomonas, Streptococcus, Yeast, or Acinetobacter (z = -1.00, p = 0.317; z = 0.00, p = 1.0; z = 0.00, p = 1.0; z = 0.00, p = 1.0; z = -1.00, p = 0.317; z = 0.00, p = 1.0; z = 0.00, p = 1.0, respectively). A statistically significant difference between fresh and refrigerated samples was found with "mixed" organisms (z = -2.565, p = 0.010) and a difference approaching significance was found with Staph aureus (z = -1.841, p = 0.066), both with colony counts of less than 50 k. No changes in cultures or colony counts occurred following refrigeration that would have resulted in altered treatment regimens. This study indicates that refrigeration of urine samples for up to 24 hours in the hospital setting rarely causes changes in identified organism type and causes no clinically significant changes in urinalysis or urine culture results in SCI patients.

Colony Count, Microbial↗
PubMed2003

Effect of controlled-release oxybutynin on neurogenic bladder function in spinal cord injury.

OBJECTIVE: This study evaluated the effects and tolerability of extended-release oxybutynin chloride on the frequency of voiding and catheterization and urodynamic capacity in spinal cord injury (SCI) patients with defined detrusor hyperreflexia. METHODS: This was a 12-week, prospective, dose-titration study of extended-release oxybutynin (oxybutynin XL). SCI patients with urodynamically defined detrusor hyperreflexia were recruited for this study. Following a 7-day washout period, patients were evaluated via video-urodynamic study and then treatment was initiated at a dosage of 10 mg per day. Dosage was increased in weekly intervals to a maximum of 30 mg per day. Micturation frequency diaries and urodynamics were completed at baseline and repeated at week 12. Tolerability information was collected at each follow-up visit. RESULTS: Ten patients (mean age = 49 years) with complete or incomplete SCI were enrolled. Participants reported clinical improvement (decreased urinary frequency and fewer incontinence episodes) with oxybutynin therapy following titration to 30 mg per day. All patients chose a final effective dosage of greater than 10 mg, with 4 patients taking the maximum of 30 mg per day. Mean cystometric bladder capacity increased from 274 mL to 380 mL (P = 0.008). No patient experienced serious adverse events during the 12-week study. CONCLUSION: Oxybutynin XL is safe and effective in patients with detrusor hyperreflexia secondary to SCI. The onset of clinical efficacy occurs within 1 week, and daily dosages up to 30 mg are well tolerated.

Adult↗
PubMed2004

Significance of bacteriuria in neurogenic bladder.

OBJECTIVE: To investigate the usefulness of performing routine urine cultures in veterans with spinal cord injury (SCI) who come for annual evaluation. RESEARCH DESIGN/PARTICIPANTS: This retrospective study was performed on asymptomatic patients who came for outpatient annual evaluation. The records of 89 healthy male veterans with SCI between the ages of 22 and 82 years (mean age = 50.6) were reviewed from March through October 2000. METHODS: The following information was collected: patient's name, social security numbers, age, year of injury, level of injury, American Spinal Injury Association (ASIA) classification, urinalysis including white blood cell (WBC) count and presence or absence of nitrite, urine culture results (> or <100,000 colony-forming units of uropathogens per milliliter), blood WBC count, and mode of bladder management. The data were analyzed statistically to look at the effects of age at injury, level of injury, injury category (ASIA classification), pyuria, urinary nitrite, serum WBC count, and mode of bladder control on the presence of bacteriuria. RESULTS: Results revealed that regardless of the level of injury, individuals with ASIA A injuries were at high risk of having bacteriuria with positive culture results. Patients who were nitrite positive and/or had > or =6 WBCs per high-powered field (HPF) in the urine were also at high risk for significant bacteriuria. CONCLUSION: Urinary tract infections (UTIs) in the SCI population frequently are asymptomatic, polymicrobial, caused by antibiotic-resistant bacteria, and very likely to recur or relapse. However, there are no data to support or justify treatment of asymptomatic bacteriuria. The present study suggests that healthy asymptomatic patients with SCI who come for annual evaluations should not have routine urine cultures if they are at low risk for UTIs; that is, <6 WBC/HPF in the urine and/or nitrite negative.

Adult↗
PubMed2006

Normal ranges of variability for urodynamic studies of neurogenic bladders in spinal cord injury.

BACKGROUND/OBJECTIVE: Urodynamic studies are conducted on a regular basis to evaluate changes in bladder function after spinal cord injury. Often, differences in urodynamic parameters exist from one study or one year to the next. The objective of this study was to provide reference ranges for "normal" variability in urodynamic parameters that can be considered as "no real change" from one study to the next. DESIGN: Retrospective chart review. METHODS: Fifty consecutive individuals with spinal cord injury had 2 trials (trial 1 and trial 2) of urodynamic studies done 5 minutes apart, and the following data were collected: maximum cystometric capacity, opening pressure, maximum detrusor pressure, volume voided, and postvoid residual. The corresponding data were compared, and the frequency distribution for the change between consecutive studies was plotted. Because there is no standard, variability ranges for 5th to 95th, 10th to 90th, and 25th to 75th percentiles were calculated to give health care providers more choices. RESULTS: Ranges of variability are as follows in the following format (urodynamic parameter; mean value; +, maximum increase; -, maximum decrease)--5th to 95th percentile: cystometric capacity (234.63 mL, +213.50 mL, -158.05 mL); opening pressure (54.56 cmH2O, +30 cmH2O, -18.00 cmH2O); maximum detrusor pressure (60.82 cmH2O, +17.35 cmH2O, -27.80 cmH2O); volume voided (122.20 mL, +177.25 mL, -176.00 mL); postvoid residual (176.06 mL, +197.25 mL, -118.00 mL); 10th to 90th percentile: cystometric capacity (234.63 mL, +126.40 mL, -74.60 mL); opening pressure (54.56 cmH2O, +13.70 cmH2O, -12.00 cmH2O); maximum detrusor pressure (60.82 cmH2O, +10.00 cmH2O, -20.00 cmH2O); volume voided (122.20 mL, +105.60 mL, -82.00 mL); postvoid residual (176.06 mL, +131.00 mL, -86.00 mL); 25th to 75th percentile: cystometric capacity (234.63 mL, +72.00 mL, -27.00 mL); opening pressure (54.56 cmH2O, +4.00 cmH2O, -9.50 cmH2O; maximum detrusor pressure (60.82 cmH2O, +4.00 cmH2O, -10.00 cmH2O); volume voided (122.20 mL, +50.00 mL, -30.00 mL); postvoid residual (176.06 mL, +50.00 mL, -30.00 mL). CONCLUSIONS: Urodynamic studies have variability. Knowing these ranges of variability can be helpful in determining whether differences between filling trial 1 and filling trial 2 in a single study or year-to-year changes in urodynamic studies are significant or simply the normal variability of the urodynamic study.

Adolescent↗
PubMed1998

Use of contact laser crystal tip firing Nd:YAG to relieve urinary outflow obstruction in male neurogenic bladder patients.

BACKGROUND AND OBJECTIVE: Endoscopic urologic procedures for transurethral prostatectomy (TURP), external sphincterotomy (TURS), bladder neck incision, and incising strictures using diathermy have resulted in excessive bleeding and risk of hyponatremia. This presentation is a review of a methodology developed to evaluate the use of contact laser crystal firing Nd:YAG laser. Details of the technique are presented. RESULTS: A review of 129 patients following laser TURS with 34% of these patients also needing TURP and 29% of patients also requiring TUIP has been done. Following contact laser endoscopic surgery, the catheter was removed in 24 hours. There was minimal to nil haemorrhage perioperatively and secondary haemorrhage was absent. CONCLUSIONS: The technique employing contact laser crystal provides an easy TURP, TURS, and stricture ablation. Follow up indicates durable results.

Equipment Design↗
PubMed1988

The value of the ice water test in the management of the neurogenic bladder.

Ice water tests (IWT) and gas cystometrograms were performed on 30 consecutive spinal cord injury in-patients on an intermittent catheterization program over a 6-month period. The tests were used to determine the presence of bladder reflex activity. A three-step grading system was formulated to clinically determine the degree of detrusor reflex activity on IWT. A 3+ IWT was used to indicate the expulsion of the catheter from the bladder and urethra following instillation of recently thawed ice; a 2+ IWT meant voiding around the catheter after instillation of 90 ml of ice water; and a 1+ IWT indicated voiding around the catheter after instilling a total of 300 ml of ice water into the bladder. The study shows that the ice water test was more sensitive test than CO2 cystometrogram in detecting the presence of detrusor reflex activity.

Adolescent↗
PubMed1995

Perinephric urinoma secondary to neurogenic bladder in myelodysplasia.

We report on a girl with infected perinephric urinoma and myelodysplasia who presented with a febrile urinary tract infection. A complex perinephric fluid collection with internal echoes was found on renal ultrasound, necessitating placement of a percutaneous drainage tube. Initial urodynamic testing after treatment of the infection revealed a noncompliant bladder with an elevated detrusor leak point pressure. Neurovesical dysfunction with elevated leak point pressure is believed to be the cause of urinoma. Clinical presentation, treatment and pathophysiology of this entity are discussed.

Cysts↗