Articles: urinary-bladder-therapy.
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The Journal of urology · Sep 1998
Bilateral chronic sacral neuromodulation for treatment of lower urinary tract dysfunction.
Chronic sacral neuromodulation aims at functional restoration of selected forms of nonneurogenic and neurogenic bladder dysfunction. The original technique, as described by Tanagho and Schmidt, provides unilateral sacral nerve stimulation via an implanted stimulator powering an electrode inserted into a sacral foramen. Its drawback was that the implant failed unpredictably in some patients despite previous successful percutaneous test stimulation. Therefore, we modified the stimulation technique to improve the efficacy of chronic sacral neuromodulation. ⋯ The efficacy of chronic sacral neuromodulation can be improved by bilateral attachment of electrodes directly to the sacral nerves.
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The Journal of urology · Aug 1995
Management of spinal cord injured patients by indwelling suprapubic catheterization.
We review the urological complications in spinal cord injury patients treated with suprapubic catheterization. ⋯ Suprapubic catheterization is an effective and safe alternative form of bladder management in select patients with spinal cord injury.
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The Journal of urology · May 1995
Comparative StudyComparison of bladder management complication outcomes in female spinal cord injury patients.
A total of 70 female spinal cord injury patients was retrospectively analyzed for outcomes of long-term bladder management. Three groups were defined: 1) 23 patients on intermittent catheterization, 2) 25 treated by reflex voiding and incontinence padding, and 3) 22 with an indwelling catheter. Mean years of using the specific bladder management technique were 8.5 +/- 4.7, 15.8 +/- 7.3 and 16.7 +/- 9.0 for the 3 groups, respectively. ⋯ The differences among the groups remained significant (p < 0.00001). Additional analyses showed highly significant differences between the catheter group and the other 2 groups (intermittent catheterization p = 0.0009 and padding p = 0.0005), and a difference that approached significance between the intermittent catheterization and padding groups (p = 0.085). The results strongly support intermittent catheterization as the optimal management of female patients following spinal cord injury given that other factors, in particular independent hand function or the need for appropriate assistance, are considered.
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Several modes of urinary tract drainage exist for the spinal cord-injured (SCI) patient, but the use of an indwelling catheter is discouraged. We retrospectively reviewed the charts of our traumatic SCI patients followed twenty years or more since initial injury to compare urinary tract preservation and the incidence of urologic complications in patients with neurogenic bladders voiding spontaneously with those using long-term indwelling catheters. Eighty-one patients with long-term injuries were identified; 73 of them fit the study criteria. ⋯ Three of the 6 patients had indwelling catheters: in 1 patient TCC developed, in 1 adenocarcinoma, and in 1 squamous cell carcinoma. In 1 patient TCC developed in a defunctionalized bladder after ileal conduit formation. Based on this study, we can conclude that in select groups of SCI patients, the choice of an indwelling catheter may be made if other methods fail, provided patients undergo regular upper urinary tract imaging and cystoscopy.
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Urol. Clin. North Am. · Aug 1993
ReviewElectrical stimulation of sacral roots for micturition after spinal cord injury.
In patients with suprasacral spinal cord injury, electrical stimulation of the sacral anterior nerve roots can produce micturition with low residual volumes of urine and reduced urinary tract infection. Voiding pressures can be maintained at acceptable levels by selective peripheral neurotomy and myotomy or, more commonly, by an intermittent pattern of stimulation. Occasionally, external sphincterotomy is required. ⋯ Penile erection is produced in a substantial proportion of male patients. The procedure has now been applied in about 700 patients with spinal cord injury, some of whom have been followed for nearly 15 years. The nerves do not appear to be damaged by long-term stimulation, and technical faults with the equipment are now uncommon.