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Purpose We present the outcomes of microwave ablation (MWA) of renal cell carcinoma (RCC) with and without pyeloperfusion. Material and methods A retrospective review of patients' records was undertaken to identify patients with RCC, who were treated with MWA with and without adjunctive pyeloperfusion. The distance between the tumour and ureter as well as the tumour size were measured on axial imaging. Pyeloperfusion was performed in nine patients in this series after placement of a ureteral stent and instilment of diluted contrast into the ureter. MWAs of the tumours were performed under computed tomography (CT) guidance. Hydrodissection was performed to displace at-risk organs. Creatinine was measured as renal function index after and before the procedure. A CT scan was performed at the end of the procedure and also after one, three, and six months, to identify the presence of residual disease and complications. Results Eighteen biopsies of proven RCC were treated with 20 sessions of MWA. The average follow-up time for this study was 180 days. The average distance between the ureter and the tumour in axial CT view was 20.8 (± 2.9) mm. Primary efficacy was achieved in 88% of pyeloperfused patients and in 100% of the non-pyeloperfused patients. Two pyeloperfused patients required secondary procedure, and full secondary efficacy was achieved for both. There was only one grade 2 urological complication, which occurred in a patient who underwent pyeloperfusion. Creatinine was not significantly different after the procedure in this study (p-value 0.4). Conclusion In this study MWAs of RCCs were successfully performed using pyeloperfusion as a protective measure against thermal injury to the ureter.

Vesicoureteral reflux (VUR) is a common urological complication in renal transplant patients.of this study is to evaluate the performance of contrast-enhanced voiding urosonography (CEvUS) in the diagnosis and classification of reflux into the renal allograft, to evaluate and classify VUR into the allograft using voiding cystourethrography (VCUG) and CEvUS, to compare the two methods, and to propose a new classification of reflux into the allograft based on CEvUS and VCUG assessment, in line with the international reflux grading system. From January 2017 to July 2019, 84 kidney transplant patients were enrolled. All patients underwent VCUG and CEvUS. In 76 cases there was agreement between VCUG and CEvUS (90 %) (Kappa = 0.7). The sensitivity of CEvUS using VCUG as the gold standard was 90 %, and the specificity was 92 %. Of the 7 cases diagnosed by VCUG and not by CEvUS, 6 were grade 1 and 1 was grade 2. Transplant patients with reflux symptoms should undergo CEvUS. If the outcome is negative, VCUG should be performed. The classification that we propose is better suited to describe VUR in transplant patients, because it is simpler and takes into account whether reflux occurs not only during urination but also when the bladder is relaxed.Vesikoureteraler Reflux (VUR) ist eine häufige urologische Komplikation bei Patienten mit Nierentransplantation. ZIEL: dieser Studie ist es, die Leistung der kontrastmittelverstärkten Miktionsurosonografie (CEmUS) bei der Diagnose und Klassifizierung des Reflux in das Nieren-Allotransplantat zu bewerten, den VUR in das Allotransplantat mittels Miktionszystourethrografie (MCU) und CEmUS zu bewerten und zu klassifizieren, die beiden Methoden zu vergleichen und eine neue Klassifikation des Reflux in das Allotransplantat basierend auf der CEmUS- und MCU-Beurteilung in Übereinstimmung mit dem internationalen Reflux-Klassifikationssystem vorzuschlagen. Von Januar 2017 bis Juli 2019 wurden 84 nierentransplantierte Patienten eingeschlossen. Bei allen Patienten wurden MCU und CEmUS durchgeführt. In 76 Fällen bestand Übereinstimmung zwischen MCU und CEmUS (90 %) (Kappa = 0,7). Die Sensitivität von CEmUS bei Verwendung der MCU als Goldstandard betrug 90 %, die Spezifität betrug 92 %. Von den 7 Fällen, die mittels MCU, aber nicht durch CEmUS diagnostiziert wurden, hatten 6 Patienten Grad 1 und 1 Patient hatte Grad 2. Transplantationspatienten mit Refluxsymptomen sollten sich einer CEmUS unterziehen. Wenn das Ergebnis negativ ist, sollte eine MCU durchgeführt werden. Die von uns vorgeschlagene Klassifikation ist besser geeignet, um den VUR bei Transplantationspatienten zu beschreiben, da sie einfacher ist und berücksichtigt, ob der Reflux nicht nur bei der Blasenentleerung, sondern auch bei entspannter Blase auftritt.

Kronična bubrežna bolest podrazumijeva oštećenje bubrežne strukture i funkcije zbog čega dolazi do progresivnog i trajnog oštećenja ekskrecijske, endokrine i metaboličke bubrežne funkcije. Dijaliza i transplantacija bubrega su suvremene metode nadomjesnog liječenja kronične bubrežne bolesti. Transplantacija bubrega je kirurški zahvat s mogućim komplikacijama. Svrha ovog rada je bila prikazati učestalost uroloških komplikacija nakon transplantacije bubrega te analizirati njihovo liječenje i ishod. Retrospektivno je analizirana medicinska dokumentacija bolesnika u kojih je od 30. siječnja 1971. godine do 31. prosinca 2019. godine u Kliničkom bolničkom centru Rijeka učinjena transplantacija bubrega te su posebno obrađene urološke komplikacije. Tijekom promatranog razdoblja učinjene su ukupno 1174 transplantacije bubrega. Urološke komplikacije imalo je ukupno 155 bolesnika (13,3%). Najčešće komplikacije su bile stenoza uretera kod 52 bolesnika (4,5%), urinarna fistula kod 50 bolesnika (4,3%), retencija urina kod 24 bolesnika (1,9%) te urolitijaza kod osam bolesnika (0,7%). Kod većine bolesnika je provedeno kirurško liječenje. U zadnje vrijeme se značajno povećalo rješavanje uroloških komplikacija korištenjem minimalno-invazivnih metoda. Rezultati ovog istraživanja pokazuju da urološke komplikacije nisu bile česte, a najčešće su bile stenoza uretera i urinarna fistula. Dio uroloških komplikacija liječen je konzervativnim, a dio kirurškim pristupom. Kod bolesnika kod kojih je potrebno kirurško liječenje, endourološke metode predstavljaju danas inicijalnu metodu liječenja., Chronic kidney disease indicated the damage of renal structure and function which leads to progressive and permanent damage of excretory, endocrine and metabolic functions of kidney. The dialysis and kidney transplantation are modern methods of replacement treatment of chronic kidney disease. Kidney transplantation is a surgical procedure with possible complications. The purpose of this study was to show the frequency of urological complications after kidney transplantation and to analyze their treatment and outcome. The medical documentation of patients with kidney transplantion operated in University Hospital Centre Rijeka from 30st January 1971 to 31st December 2019, were retrospectively analyzed and urological complications were elaboreted. In the observed period, 1174 kidney transplantations were performed. Urological complications were noticed in the 155 patients (13,3%). The most frequent complications were ureteral stenosis in 52 patients (4,5%), urinary fistula in 50 patients (4,3%), urinary retention in 24 patients (1,9%) and urolithiasis in the eight patients (0,7%). The majority of the patients underwent surgical treatment. Recently, minimally invasive surgery was the method of choice for treatment of urological complications. The result of this study shows that urological complications were not frequent and the most frequent were ureteral stenosis and urinary fistula. Partly urological complications were treated conservatively and partly with surgical approach. In the group of patients that required surgical treatment, endourological methods are currently the initial treatment modality

INTRODUCTION AND OBJECTIVE:Ureteric stricture is the most common urological complication post transplant(3%), with majority(73%) of them occuringat the distal end. Success rate of primary endo-urol...

The overall complication rate of Transurethral resection of prostate (TURP) is about 11.1%. Amongst all complications, ocular complications are one of the rarest. In this paper, we present a case of vision loss due to paradoxical embolism as a rare complication following TURP. Ocular complications are very rare in urological surgeries but can happen due to paradoxical embolism following patent foramen ovale. Therefore, we recommend the early diagnosis and treatment of PFO prior to this type of surgery.

Indication has led ureteroscopy to be a worldwide technique, with the expected appearance of multiple complications. The ureteral avulsion is an uncommon severe urological complication of ureteroscopy (URS). Surgery in patients with a total ureteral loss is a demanding challenge for urologist. It requires usually immediate open or laparoscopic intervention. This case report was to present the treatment modality after ureteral avulsion. We have presented a case of 58-year-old male patient who underwent a successful repair of an upper ureteral injury. We have comprehensively described the effectiveness of an extended Boari-flap procedure for reconstruction after iatrogenic ureteral trauma. Particularly in an unexpected and casual situations, the presented extended Boari flap modification can be a great alternative for reconstructing a total ureteral loss. In conclusion we have recommend useful tips, how to counteract such unwanted events.

Background Menkes disease (MD) is a rare X-linked hereditary multisystemic disorder that is caused by dysfunction of copper metabolism. Patients with MD typically present with progressive neurodegeneration, some connective tissue abnormalities, and characteristic “kinky” hair. In addition, various types of urological complications are frequent in MD because of underlying connective tissue abnormalities. In this study, we studied the clinical features and outcomes of MD, focusing on urological complications. Methods A total of 14 unrelated Korean pediatric patients (13 boys and 1 girl) with MD were recruited, and their phenotypes and genotypes were analyzed by retrospective review of their medical records. Results All the patients had early-onset neurological deficit, including developmental delay, seizures, and hypotonia. The girl patient showed normal serum copper and ceruloplasmin levels as well as milder symptoms. Mutational analysis of the ATP7A gene revealed 11 different mutations in 12 patients. Bladder diverticula was the most frequent urological complication: 8 (57.1%) in the 14 patients or 8 (72.7%) in the 11 patients who underwent urological evaluation. Urological imaging studies were performed essentially for the evaluation of accompanying urinary tract infections. Four patients had stage II chronic kidney disease at the last follow-up. Conclusion Urologic problems occurred frequently in MD, with bladder diverticula being the most common. Therefore, urological imaging studies and appropriate management of urological complications, which may prevent or reduce the development of urinary tract infections and renal parenchymal damage, are required in all patients with MD., Graphical Abstract

This article reports the current evidence and expert opinions on the diagnosis and management of neurogenic lower urinary tract dysfunction (NLUTD) in Taiwan. The main problems of NLUTD are failure to store, failure to empty, and a combination of these two. Priorities in the management of NLUTD, in order of importance, should be the following: (1) preservation of renal function; (2) freedom from urinary tract infection; (3) efficient bladder emptying; (4) freedom from indwelling catheters; (5) patient agreement with the management modality; and (6) avoidance of medication after proper management. Management of the urinary tract in patients with spinal cord injuries or multiple sclerosis must be based on urodynamic findings rather than on inferences from the neurological evaluation. Identification of high-risk patients is important to prevent renal functional impairment in those with chronic NLUTD. The lower urinary tract function of patients with NLUTD should be regularly followed up by urodynamic study, and any urological complication should be treated adequately. Avoiding a chronic indwelling catheter can reduce the incidence of developing a low compliant bladder. Intravesical instillation of vanilloids and injecting botulinum toxin-A are alternative treatments for refractory detrusor overactivity or a low compliant bladder, and can replace the need for bladder augmentation. When surgical intervention is necessary, less invasive types of surgery and reversible procedures should be considered first, and any unnecessary surgery in the lower urinary tract should be avoided. Keeping the bladder and urethra in good condition without the interference of neuromuscular continuity provides patients with NLUTD the opportunity to use new technologies in the future. Improving the quality of life in patients with neurogenic voiding dysfunction is the most important aspect of treatment.

Ureteric stricture is the most common urological complication following renal transplantation. Management often involves endo-urological interventions and open surgery. The definitive treatment is surgical reconstruction to restore continuity. Where this is not possible or contra-indicated and a stent cannot be placed in the ureter, an extra-anatomic stent (EAS) could be used to bypass a complete ureteric obstruction. Using an existing nephrostomy tract, a percutaneous stent is placed in the kidney and is tunneled under the skin into the bladder establishing extra-anatomical urinary drainage. We report the use of a novel EAS system in a patient with transplant ureteric stricture when antegrade stent placement or surgical reconstruction was not possible.

Summary Renal transplantation is the best renal replacement treatment. It provides longer survival and a better quality of life. The outcome of renal transplantation is influenced by the occurrence of various complications, including urological. One of the most frequently occurring complications is lymphocele. Most cases of lymphocele develop during a period of several weeks after the procedure of transplantation. However, there are some literature reports concerning lymphocele diagnosis in the later period, even after several years. Most cases of lymphocele are asymptomatic and are diagnosed accidentally. Nevertheless, a large lymphocele may press the kidney, ureter, urinary bladder or neighbouring blood vessels, causing deterioration of renal function, leg oedema and thrombosis of iliac vessels. Among other complications there are Streszczenie Przeszczep nerki jest najlepszą metodą leczenia nerkozastepczego, zapewniającą pacjentom dluzsze przezycia i lepszą jakośc zycia. Na wynik leczenia przeszczepianiem nerki wplywa wystepowanie powiklan, w tym urologicznych. Jednym z najcześciej wystepujących jest limfocele. Wiekszośc pojawia sie podczas kilku tygodni po zabiegu transplantacji, zdarzają sie jednak przypadki wystepowania limfocele w poźniejszej obserwacji. Przewaznie nie dają objawow klinicznych i są wykrywane przypadkowo. Jednak gdy limfocele ma duze rozmiary moze uciskac na przeszczepioną nerke, moczowod, pecherz moczowy lub okoliczne naczynia i pogarszac funkcje przeszczepionego narządu, powodowac obrzek konczyny oraz zakrzepice naczyn biodrowych. Do powiklan limfocele nalezą tez zakazenia. Przyczyną jego powstania jest gromadzenie sie chlonki pochodzącej z uszkodzonych naczyn limfatycznych otaczających naczynia biodrowe lub z naczyn limfatycznych przeszczepianej nerki. Czynnikami predysponującymi są stosowane leczenie immunosupresyjne, w tym inhibitory mTOR, pochodne kwasu mykofenolowego oraz wysokie dawki glikokortykosteroidow. Wystąpieniu limfocele sprzyjają rowniez otylośc, cukrzyca, zaawansowany wiek biorcy, dlugi czas cieplego niedokrwienia, epizody ostrego odrzucania i opoźnienie podjecia funkcji przez przeszczepioną nerke. Autorzy opisują dostepne obecnie metody leczenia, w tym aspiracje i drenaz przezskorny z i bez sklerotyzacji, drenaz z zastosowaniem cewnika Tenckhoffa, a takze fenestracje laparoskopową i otwartą. Obecnie za najefektywniejszą, ale takze najbezpieczniejszą uwazana jest fenestracja laparoskopowa, chociaz istnieją sytuacje kliniczne, w ktorych konieczny jest otwarty zabieg operacyjny.

Context: Urological complications are inevitable in renal transplantation; however, their occurrence and brunt on graft survival can be downsized. The aim of our study was to analyze and review the literature on various urological complications and their management in renal transplant patients. Materials and Methods: We reviewed all cases of urological complications in renal transplantation managed at our institution from January 2010 to March 2017. Results: Urological complications arose in 29 renal transplant patients amidst the study period with median identification time of 24 days (range 0–1500 days). Ten (34.5%) patients developed complications pertaining to ureteric handling and reimplantation followed by significant lymphocele in 9 (31%) patients. Four (13.8%) cases succumbed to vascular anastomosis-related complications. Out of 29 patients, 45% of these complications manifested within a month posttransplant. Complications were tackled individually. Sixteen (55%) cases were treated with either endoscopic or minimally invasive methods, whereas 13 (45%) cases required open surgery. Two grafts were lost as a consequence of vascular complications and a fatality which was directly or indirectly linked with urological complication. Remaining all treated patients improved on follow-up. Conclusion: Comprehensive preoperative recipient evaluation, meticulous organ procurement, and integrated multidisciplinary teamwork are helpful in achieving optimal outcome of transplant. Endourological and minimally invasive procedures are emerging as main modality in the management of these complications; however, many cases still requires contemporary surgical management.

Summary Urological complications after kidney transplantation may result in significant morbidity and mortality. However, the incidence of such complications after deceased cardiac death (DCD) donor kidney transplantation and their effect on survival is unknown. Purpose of this study was to estimate the incidence of urological complications after DCD kidney transplantation, and to estimate their impact on survival. Patient records of all 76 DCD kidney transplantations in the period 1997–2004 were reviewed for (urological) complications during the initial hospitalization until 30 days after discharge, and graft survival until the last hospital visit. Urological complications occurred in 32 patients (42.1%), with leakage and/or obstruction occurring in seven patients (9.2%). The latter seems to be comparable with the incidence reported in the literature for deceased heart-beating (DHB) transplantations (range 2.5–10%). Overall graft survival was 92% at 1 year and 88% at 3 years, comparable to the rates reported in the literature for kidneys from DHB donors, and was not affected by urological complications (χ2 = 0.27, P = 0.61). Only a first warm-ischaemia time of 30 min or more reduced graft survival (χ2 = 4.38, P

Background Urological complications are frequent in Menkes syndrome, a very rare X-linked recessive disorder of copper (Cu) metabolism. Aim To evaluate the role of Cu therapy in preventing the progression of urological complications. Subjects and methods We retrospectively enrolled 57 patients with Menkes syndrome (55 published case reports and two of our own unpublished cases) and investigated the reported urological complications, distinguishing the patients with or without Cu replacement therapy and evaluating the efficacy of this therapy in the prevention of urological complications. Results The most frequent urological complication was bladder diverticulum (38.6% of the total patients); obstruction bladder outflow and rupture of the kidney were less frequent (both 1.8% of the total). The number of congenital urological complications increased progressively by age category; in fact, 77.8% of patients did not report urological complications at the age of 0.4+/-0.2 y, and 28.6% of them displayed > or = two congenital urological complications at the age of 9.3+/-2.6 y. The percentage of urological complications found in younger patients not on Cu therapy did not differ from that of older patients treated with Cu therapy. A comparison between patients of the same age interval, who were or were not treated with Cu, showed that treated children had fewer urological complications than untreated children. Conclusion Our investigation suggests that Cu therapy in patients with Menkes syndrome does not prevent the progression of urological complications; however, it might delay their worsening.

The most serious urological complication of endometriosis is hydronephrotic renal atrophy secondary to ureteric involvement. As only half of these patients are symptomatic, it is commonly diagnosed late and more by the clinicians awareness and suspicion of this entity. We report a case of an unmarried young female who presented primarily with left loin pain of 2-year duration. She was found to have lower ureteric stricture by an IVU done by her referring doctor. Further workup at our center showed that she had pelvic endometriosis with hydronephrosis secondary to extrinsic ureteric endometriosis. She had a first-degree relative with the same disease. She had no menstrual problems. Diagnostic laparoscopy, biopsy of the lesion, ureteric dilatation with stenting, along with hormonal treatment was given to her as first line of treatment. There was no improvement of the ureteric obstruction even after 6 months of treatment. Finally, surgical excision of the endometrioma, left oophorectomy, along with resection of the ureteric stricture with uretero-ureterostomy was done. This case report includes details of her further management and outcome along with a brief review of literature.

An intraperitoneal bladder perforation occurred during transurethral tumor resection under general anesthesia in a 82 year old woman. The bladder was repaired with a laparoscopic closure and an indwelling urethral catheter. The histopathology revealed T1 high grade urothelial carcinoma. The patient recovered well and was discharged home on postoperative day 7. This case highlights the successful use of laparoscopy in the treatment of a rare urological complication.

The indications for ureteral stent placement have expanded significantly with the progress of surgical procedures and techniques. Although such stents are now an integral part of contemporary urological practice, their use is not free of complications and consequences. There are very rare descriptions of knot formation in a ureteral stent and the consequences of this occurrence, with only 12 cases previously reported. Here, we report an additional case and review all the literature concerning this urological complication with emphasis on its predisposing factors and conservative and surgical management.

Bladder calculi are the second most common urological complication in those with spinal cord injury (SCI). Detection and removal of bladder stones are important to prevent possible complications.To determine the accuracy of bladder stone detection based on catheter encrustation in asymptomatic individuals with SCI.Prospective cohort study.Cystoscopy findings in persons with SCI who were noted to have catheter encrustation at the time of catheter removal for their scheduled cystoscopy were used in this prospective study. Indwelling catheters were examined for encrustation at the time of removal as they were being prepared for cystoscopy. Cystoscopy was performed, and the presence or absence of bladder stones was noted.Presence or absence of bladder stones detected with cystoscopy in those with precystoscopy catheter encrustation.Forty-nine individuals with indwelling catheters were evaluated. Overall, 17/49 (35%) individuals in this study had bladder stones. Catheter encrustation was noted in 13 patients. Of these 13 patients, 11 also had bladder stones. In other words, a positive result for catheter encrustation had a positive result for bladder stones 85% of the time. Thirty-six individuals had no catheter encrustation. Of these, 6 (16%) were found to have bladder stones.Encrustation of a catheter is highly predictive of the presence of bladder stones. This suggests that cystoscopy should be scheduled in a person undergoing a catheter change if catheter encrustation is noted.

Recurrent functional and anatomical subvesical obstruction as urological complication in a tetraplegic patient

BACKGROUND The objects of this study is to evaluate the ipsilateral stone recurrence who became stone free status after extracorporeal shock wave lithotripsy (ESWL). METHODS Three hundred ninety five patients who became stone free after ESWL with Lithostar and followed more than 6 months, were analyzed stone recurrence. Stone recurrence were diagnosed by KUB and/or ultrasound. Actual recurrence free rate were calculated based on the period from the day of achieved stone free status to the day of estimated recurrence. Eight factors examined included sex, side, number, location, size, stone history urological complication, hydronephrosis and also contralateral recurrence was analyzed. RESULTS Over all ipsilateral recurrence free rate were 96.5%, 78.8%, 65.3% after 1, 3 and 5 years, respectively. Contralateral stone free rate were 98.1%, 92.5%, 87.2% after 1, 3 and 5 years. Five-year recurrence free rate according stone factors, there were significant difference in stone number (Single 71.1% and multiple 31.6%), in stone history (with history 77.1% and without 35.7%), in urological complication (without complication 67.7% and with complication 35.7%). However, there were no significant difference in sex, side, stone, location, stone size and hydronephrosis. CONCLUSION This results suggested that the stone number, stone history and urological complication were highly related to ipsilateral stone recurrence after stone free status by ESWL. Extracorporeal shock was lithotripsy had probability of higher stone recurrence rate.

ResumenLa hiperplasia benigna de próstata (HPB) es una enfermedad con alta prevalencia entre los varones de más de 50 años que requiere una continuidad asistencial entre los 2 niveles existentes en nuestro país, el de atención primaria (AP) y el de atención especializada; motivo por el que era necesario consensuar unos criterios de derivación o de continuidad que sirvan de orientación a ambos colectivos. La historia clínica del paciente, el Índice Internacional de Síntomas Prostáticos (IPSS, International Prostate Symptom Score), el tacto rectal y el antígeno prostático específico (PSA, prostate-specific antigen) son herramientas accesibles en el ámbito de la AP que permiten un diagnóstico adecuado de la HBP. Conscientes de tal necesidad, las sociedades científicas de atención primaria (Sociedad Española de Médicos de Atención Primaria [SEMERGEN], Sociedad Española de Medicina General [SEMG] y Sociedad Española de Medicina de Familia y Comunitaria [semFYC]) y la Asociación Española de Urología (AEU) elaboraron este documento de consenso. A los pacientes con IPSS20, PSA >10 ng/ml o PSA >4 ng/ml y PSA libre 1.5ng/ml combined treatment and evaluation at the first and sixth month is recommended. Some clear criteria for referral to urology are established in this document, which help in the management of these patients. Those patients with BPH who do not show any improvement at the third month of treatment with α-blockers, or the sixth month with 5α-reductase inhibitors, will be referred to urology. Patients will also be referred to urology if they have lower urinary tract symptoms, a pathological finding during rectal examination, IPSS>20, PSA>10ng/ml or PSA>4ng/ml and free PSA

This article reports the current evidence and expert opinions on diagnosis and management of neurogenic lower urinary tract dysfunction (NLUTD) in Taiwan. The main problems of NLUTD are failure to store, failure to empty, and combined failure to store and empty. The priority of management of NLUTD should follow the order of: (1) preservation of renal function; (2) freedom from urinary tract infection (UTI); (3) efficient bladder emptying; and (4) freedom from indwelling catheter, and patients' expectation of management should be respected. Management of the urinary tract in patients with spinal cord injury (SCI) or multiple sclerosis (MS) must be based on urodynamic findings, rather than inferences from the neurologic evaluation. Selecting high risk patients is important to prevent renal function impairment in patients with chronic NLUTD. Patients with NLUTD should be regularly followed up for their lower urinary tract dysfunction by urodynamic study and any urological complication should be adequately treated. Avoiding a chronic indwelling catheter can reduce the incidence of developing a low compliant bladder. Antimuscarinic agents with clean intermittent catheterization (CIC) may reduce urological complications and improve quality of life (QoL) in patients with NLUTD. Intravesical injection of botulinum toxin A provides an alternative treatment for refractory detrusor overactivity (DO) or low compliant bladder and can replace the need for bladder augmentation. When surgical intervention is necessary, we should consider the least invasive type of surgery and reversible procedure first and avoid any unnecessary surgery of the lower urinary tract. Keeping the bladder and urethra in a good condition without interference of the neuromuscular continuity provides patients with NLUTD a chance for future new technologies. It is most important to never give up on improving the QoL in patients with NLUTD.

ObjectivesNeurogenic voiding dysfunction (NVD) results in lower urinary tract symptoms and upper urinary tract complications. Management of urinary tract dysfunction in patients with spinal cord injury (SCI) must be based on patient needs and urological complications. This study surveyed the bladder management and urological complications in patients with SCI in Taiwan.Materials and methodsA total of 894 patients with SCI were surveyed throughout Taiwan over a period of 5 years (2007–2011). All patients received neurological and urological examinations, renal sonography, bladder sonography, and urinalysis. They were further requested to report urinary tract infections (UTI), voiding conditions, and bladder management in the past 3 years. The bladder management and urological complications were analyzed based on different SCI levels and duration of disease.ResultsAmong all patients, 39.7% voided spontaneously or by reflex, 23.8% used percussion to void, 20.9% voided by abdominal pressure, 18.1% used clean intermittent catheterization (CIC), and 22.9% had indwelling catheters or cystostomy. Detrusor sphincter dyssynergia (DSD) was noted in 39.7% of patients and autonomic dysreflexia (AD) in 19.9%. UTI was noted in 483 (54%) patients, hydronephrosis in 110 (12.3%) patients, and severe urinary incontinence in 257 (28.7%) patients. UTI occurred significantly more often in patients without, than with normal voiding. CIC was more frequently used in patients with duration of SCI 5 years chose indwelling catheters or a cystostomy more often than CIC.

The main problems in neurogenic voiding dysfunction (NVD) are failure to store, failure to empty, and combined failure to store and empty. The management priorities in NVD should be as follows, in order: (1) preservation of renal function, (2) freedom from urinary tract infection, (3) efficient bladder emptying, (4) freedom from an indwelling catheter, (5) patient satisfaction with voiding management and (6) avoiding medication after proper management. Management of the urinary tract in patients with spinal cord injury must be based on urodynamic findings rather than inferences from a neurologic evaluation. Selecting high-risk patients is important to prevent renal function impairment in patients with chronic NVD. Patients with NVD should be regularly followed-up for lower urinary tract dysfunction using urodynamic study and any urological complication should be adequately treated. Avoiding a chronic indwelling catheter can reduce the incidence of developing a low compliant bladder. Intravesical instillation of vanilloids or injection of BOTOX provides an alternative treatment for refractory detrusor overactivity or low compliant bladder and can replace the need for bladder augmentation. When surgical intervention is necessary, a less invasive type of surgery and a reversible procedure should be considered first and unnecessary surgery in the lower urinary tract should be avoided. Keeping the bladder and urethra in good condition without interfering with neuromuscular continuity will give patients with NVD a chance to benefit from new technologies in the future. It is most important that the physician continues to try to improve the quality of life of patients with NVD. [Tzu Chi Med J 2008;20(1):35–39]