Urethral versus suprapubic catheter: Choosing the best bladder management for male spinal cord injury patients with indwelling catheters
ABSTRACT Bladder management for male patients with spinal cord injury (SCI) challenges the urologist to work around physical and social restrictions set forth by each patient. The objective of this study was to compare the complications associated with urethral catheter (UC) versus suprapubic tube (SPT) in patients with SCI.
A retrospective review of records at Long Beach Veterans Hospital was carried out to identify SCI patients managed with SPT or UC. Chart review identified morbidities including urinary tract infection (UTI), bladder stones, renal calculi, urethral complications, scrotal abscesses, epididymitis, gross hematuria and cancer. Serum creatinine measurements were evaluated to determine whether renal function was maintained.
In all, 179 patients were identified. There was no significant difference between the two catheter groups in any areas in which they could be compared. There were catheter-specific complications specific to each group that could not be compared. These included erosion in the UC group and urethral leak, leakage from the SPT and SPT revision in the SPT group. Average serum creatinine for the UC and SPT groups was 0.74 and 0.67 mg per 100 ml, respectively.
SCI patients with a chronic catheter have similar complication rates of UTIs, recurrent bladder/renal calculi and cancer. Urethral and scrotal complications may be higher with UC; however, morbidity from SPT-specific procedures may offset benefits from SPT. Serum creatinine was maintained in both groups. Overall, bladder management for patients with chronic indwelling catheters should be selected on the basis of long-term comfort for the patient and a physician mind-set that allows flexibility in managing these challenges.
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ABSTRACT: This review of management of the neurogenic bladder due to spinal cord injury focuses specifically on the most current literature (2007–2009) regarding therapies offered in the United States. Urodynamic surveillance, indwelling and intermittent catheterization, sphincterotomy, urinary diversion, continent catheterizable stomas, and botulinum toxin usage are all reviewed. KeywordsSpinal cord injury-Neurogenic bladder-Indwelling catheter-Urinary diversion-Botulinum toxin type A-UrodynamicsCurrent Bladder Dysfunction Reports 06/2010; 5(2):107-113. DOI:10.1007/s11884-010-0047-6
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ABSTRACT: The 2 major functions of the lower urinary tract are the storage and emptying of urine. These processes are controlled by complex neurophysiologic mechanisms and are subject to injury and disease. When there is disruption of the neurologic control centers, dysfunction of the lower urinary tract may occur. This is sometimes referred to as the "neurogenic bladder." The manifestation of dysfunction depends on the level of injury and severity of disruption. Patients with lesions above the spinal cord often have detrusor overactivity with no disruption in detrusor-sphincter coordination. Patients with well-defined suprasacral spinal cord injuries usually present with intact reflex detrusor activity but have detrusor sphincter dyssynergia, whereas injuries to or below the sacral spinal cord usually lead to persistent detrusor areflexia. A complete gynecologic, urologic, and neurologic examination should be performed when evaluating patients with neurologic lower urinary tract dysfunction. In addition, urodynamic studies and neurophysiologic testing can be used in certain circumstances to help establish diagnosis or to achieve better understanding of a patient's vesicourethral functioning. In the management of neurogenic lower urinary tract dysfunction, the primary goal is improvement of a patient's quality of life. Second to this is the prevention of chronic damage to the bladder and kidneys, which can lead to worsening impairment and symptoms. Treatment is often multifactorial, including behavioral modifications, bladder training programs, and pharmacotherapy. Surgical procedures are often a last resort option for management. An understanding of the basic neurophysiologic mechanisms of the lower urinary tract can guide providers in their evaluation and treatment of patients who present with lower urinary tract disorders. As neurologic diseases progress, voiding function often changes or worsens, necessitating a good understanding of the underlying physiology in question.01/2014; 20(2):65-75. DOI:10.1097/SPV.0000000000000058
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ABSTRACT: The results of vertical falling film experiments on the absorption of water vapor to aqueous lithium bromide solutions with an additive, 2-ethyl-1-hexanol, are reported. During the absorption, the film becomes highly turbulent. Consequently, the heat and mass transfer is significantly enhanced by turbulent mixing. In addition, the instability mechanisms are detailed. In the vicinity of water absorption, surface-tension gradients due to the lower LiBr concentration, the lower additive concentration, and the higher temperature at the interface, can favor instability of the falling film.RésuméOn rapporte les résultats d'expériences effectuées sur l'absorption de vapeur d'eau par des solutions aqueuses de bromure de lithium, en films tombants, avec un additif: le 2-ðhyl-1-hexanol. Au cours de l'absorption, le film devient très turbulent. Par conséquent, le transfert de chaleur et de masse est fortement augmenté par la turbulence. On examine également les mécanismes d'instabilité. Dans le voisinage des zones d'absorption de l'eau, les variations de tension superficielle dues à une concentration plus faible en bromure de lithium, à la concentration plus faible de l'additif et à la température plus élevée à l'interface peuvent favoriser l'instabilité du film tombant.International Journal of Refrigeration 06/1996; 19(5-19):322-330. DOI:10.1016/S0140-7007(96)00025-4 · 1.70 Impact Factor