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Rehabilitation Practice and Science

Translated Title

神經性膀胱功能障礙及上尿路併發症追蹤與治療：病例報告

Abstract

In spinal cod injury (SCI) patients with neurogenic bladder dysfunction (NBD), detrusor hyperreflexia and poor bladder compliance may lead to increased intravesical pressure and other adversities, including urinary tract infection, hydronephrosis, vesicoureteral reflux, and impairment of renal function. The primary objectives of urologic care after SCI are to provide an acceptable method for managing the lower urinary tract, to prevent urinary complications, and to preserve renal function. Because urologic status can change or deteriorate many years after the initial injury, sometimes without symptoms, lifelong urologic follow-up is fundamental for all SCI patients with NBD. Strategy of bladder management in individuals with SCI should be based on urodynamic findings.We report a 22-year-old woman who was admitted with voiding dysfunction and paralysis of lower limbs secondary to complete SCI from a lumbar spine injury. The initial urodynamic study demonstrated a low intravesical pressure one month after injury, without contraction of detrusor or external urethral sphincter. The NBD was classified a lower motor neuron bladder type. Because Valsalva and Credé maneuvers worked well, she was able to establish a balanced bladder with a low voiding pressure and a low postvoid residual (PVR). Uninhibited detrusor contraction gradually developed two years later, which produced a high intravesical pressure and upper urinary tract damage. Renal sonography and renal scan revealed hydronephrosis and impairment of renal excretory function. The videourodynamic study demonstrated detrusor hyperreflexia with a voiding pressure of 93 cm H2O, low bladder compliance and concurrent urethral sphincter inactivity. The diagnosis of mixed type NBD was made two years postinjury. In order to achieve intravesical pressure less than 40 cm H2O and low PVR, utilization of anticholinergic therapy (tolterodine, 2 mg twice a day) and clean intermittent catheterization (CIC), every four to six hours, were performed. Three months later, the patient resumed a normal voiding pressure and a low PVR of less than 100 ml. Beyond our expectation, she had resolution of hydronephrosis and improvement of renal function after combing CIC with anticholinergic medication.

Language

Traditional Chinese

First Page

119

Last Page

125

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