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Rehabilitation Practice and Science

Translated Title

脊髓損傷併發膀胱結石及膀胱輸尿管逆流：病例報告

Abstract

A 25 years old male patient suffered from L1 compression fracture with weakness of both lower extremities and neurogenic bladder dysfunction 7 years prior to admission. Motor recovery over both lower extremities developed gradually that he could walk with bilateral axillary crutches later. However, the detrusor reflex did not restore so that a transurethral catheter had been left ever since he was injured. Frequent urinary tract infection manifested with fever and cloudy urine occurred off and on in the past years. Neither regular follow up nor urinary tract imaging study had been performed. Upon admission to our hospital, 5 bladder stones measuring up to 3.5x2.5x1.5 Cm3 and bilateral vesico-ureteral reflux (GrIII/V) were revealed. Cystolithotomy was done, stones weighed 81 gms with 83% magnesium ammonium phosphate and 17% calcium phosphate in composition. The urinary tract infection was under control after surgery. Cystometry study showed detrusor areflexia with sustained urethral sphincter contraction, and the vesico-ureteral reflux (VUR) occurred in low intravesical pressure, an transurethral indwelling catheter was applied.Four months after discharge, cystogram study revealed persistent bilateral low pressure VUR, and urethral sphincterotomy was therefore performed. After surgery, the post-voiding residuals was less than 50 ml. However, an external urinal was applied for stress incontinence. A cystogram study was followed 6 months later, and transient GrII VUR was found over the left ureter, radioisotope renogram study showed prompt excretion of the isotope. Six months after sphincterotomy, only one episode of urinary tract infection was noted. The patient is very satisfied with the significant improvement of life quality and health situation. As what we try to emphasize, regular follow up of urinary tract function and imaging study are essential for early diagnosis of urological complications in spinal cord injured patients. Urethral sphincterotomy is one of the effective treatments for VUR even in the absence of detrusor contraction.

Language

Traditional Chinese

First Page

59

Last Page

64

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