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Rehabilitation Practice and Science

Hann-Chorng Kuo

Translated Title

慢性脊髓損傷病人排尿障礙之泌尿科處置

Abstract

Chronic spinal cord injury (SCI) results in various dysfunctions of the urinary bladder and urethra. These neurological deteriorations after SCI cause varying urological symptoms and complications. Early detection of high risk SCI patients is important. Regular determination of intravesical pressure, residual urine and leak point pressure can provide information to avoid upper tract deterioration. Agg-ressive urological management can reduce the mortality rate from urinary tract infection (UTI) and a better quality of life can thus ensue. In the management of urological sequalae of SCI, preservation of renal function, freedom from UTI, freedom from indwelling catheter, and continence should be the aims. The primary goal of bladder management in the patient with SCI is to achieve adequate bladder drainage, low-pressure urine storage, and low-pressure voiding. This will help prevent UTI, bladder wall damage, bladder overdistention, vesicoureteral reflux, and stone disease. An intravesical pressure of less than 40 cmH2O is essential for this goal. If hydronephrosis or recurrent UTI persists, surgical int-ervention is indicated in order to increase bladder capacity, decrease intravesical pressure, or decr-ease bladder outlet resistance. The surgical procedures include cystostomy, bladder augmentation, continent urinary diversion (Kock pouch or hemi-Kock with continent cystostomy), ureteral reimplan-tation, and external sphincterotomy. External sphincterotomy has proven to be successfully in treating recurrent UTI and intractable autonomic dysreflexia or detrusor external sphincter dyssynergia in most patients. Enterocystoplasty and continent urinary diversion have been documented to have several advantages: (1) increasing in bladder capacity; (2) decreasing in intravesical pressure; (3) regaining urinary continence, and (4) regaining bladder full sensation. Study shows that more than 80% of the patients with SCI were satisfied with active urological management. Since urinary dysfunction remains the most important issue in the quality of life of chronic SCI patients apart from physical movement, a more aggressive attitude in urinary management following SCI is necessary in order to improve their quality of life.

Language

Traditional Chinese

First Page

195

Last Page

211

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