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Urological management of paraplegic patients

Tinckler LF

Med J Malaya, 1966 Mar;20(3):205-14.
PMID: 4223071
Matched MeSH terms: Urinary Bladder, Neurogenic/therapy*
Fulltext Urodynamic evaluation of lower urinary tract function in the neurogenic bladder

Mahamooth Z, Mahamooth T, Omar A

Med J Malaysia, 1985 Jun;40(2):120-4.
PMID: 3834282

Analysis of the investigations of 14 cases of spinal injury are presented. The significance of the level of injury and the pattern of bladder function is alluded too. Some aspects of the management of neurogenic bladder are discussed.

Matched MeSH terms: Urinary Bladder, Neurogenic/etiology; Urinary Bladder, Neurogenic/physiopathology*
Diagnostic accuracy of single channel cystometry for neurogenic bladder diagnosis following spinal cord injury: a pilot study

Zamli AH, Ratnalingam K, Yusmido YA, Ong KG

Spinal Cord Ser Cases, 2017;3:16044.
PMID: 28503317 DOI: 10.1038/scsandc.2016.44

INTRODUCTION: This is a cross-sectional study of 1 year duration (August 2013 to August 2014). The objective of the study was to investigate the diagnostic accuracy of single channel cystometry (SCC) for confirmation of neurogenic bladder following spinal cord injury.
MATERIALS AND METHODS: The study was conducted in both out-patient and in-patient services of Department of Rehabilitation Medicine, Hospital Sungai Buloh, Malaysia. Subjects in the study include sixteen patients with a clinical diagnosis of neurogenic bladder following spinal cord injury aged between 15 and 62 years. Patients with a clinical diagnosis of neurogenic bladder were subjected to cystometric evaluation using SCC in our hospital. Confirmation of the diagnosis was made by urodynamic study (UDS) in another hospital. SCC procedure involved manual intra-vesical pressure assessment using a 12F Nelaton catheter. Cystometric parameter measurement taken in this study was detrusor pressure (cm H2O) done at regular intervals from baseline, throughout bladder filling phase and voiding/leaking phase. The relationship between detrusor pressure to bladder volume from initial bladder filling until voiding or leaking phase was recorded, analyzed and graph plotted. Maximum detrusor pressure (cm H2O) during bladder filling, voiding or leaking and the maximum cystometric capacity (mls) was recorded.
RESULTS: SCC was found to have 100% sensitivity, 50% specificity, 93.33% positive predictive value and 100% negative predictive value for neurogenic bladder diagnosis. Only 55.55% patients with SCC suspicion of detrusor sphincter dyssynergia (DSD) had comparable UDS findings.
DISCUSSION: The use of SCC may be considered for objective confirmation of neurogenic bladder diagnosis following spinal cord lesion in centers with limited access to UDS. However, we are not able to establish its clinical application for confirmation of DSD.

Study site: Department of Rehabilitation Medicine, Hospital Sungai Buloh, Malaysia

Matched MeSH terms: Urinary Bladder, Neurogenic*
Renal scarring and chronic kidney disease in children with spina bifida in a multidisciplinary Malaysian centre

Kanaheswari Y, Mohd Rizal AM

J Paediatr Child Health, 2015 Dec;51(12):1175-81.
PMID: 26041512 DOI: 10.1111/jpc.12938

The aim of this study was to determine the occurrence of renal cortical scarring and chronic kidney disease (CKD) in children with neurogenic bladder secondary to spina bifida (SB) managed at the Universiti Kebangsaan Malaysia Medical Centre. The secondary objective was to identify the clinical factors associated with these adverse outcomes.

Matched MeSH terms: Urinary Bladder, Neurogenic
Factors influencing bladder management in male patients with spinal cord injury: a qualitative study

Engkasan JP, Ng CJ, Low WY

Spinal Cord, 2014 Feb;52(2):157-62.
PMID: 24276416 DOI: 10.1038/sc.2013.145

STUDY DESIGN: Qualitative study using individual in-depth interviews.
OBJECTIVES: The objective of this study was to explore the factors influencing the choice of bladder management for male patients with spinal cord injury (SCI).
SETTING: Public hospitals in Malaysia.
METHODS: Semistructured (one-on-one) interviews of 17 patients with SCI; 7 were in-patients with a recent injury and 10 lived in the community. All had a neurogenic bladder and were on various methods of bladder drainage. Interviews were audio-recorded, transcribed verbatim and analyzed using thematic analyses.
RESULTS: The choice of bladder management was influenced by treatment attributes, patients' physical and psychological attributes, health practitioners' influences and social attributes. Participants were more likely to choose a treatment option that was perceived to be convenient to execute and helped maintain continence. The influence of potential treatment complications on decision making was more variable. Health professionals' and peers' opinions on treatment options had a significant influence on participants' decision. In addition, patients' choices depended on their physical ability to carry out the task, the level of family support received and the anticipated level of social activities. Psychological factors such as embarrassment with using urine bags, confidence in self-catheterization and satisfaction with the current method also influenced the choice of bladder management method.
CONCLUSION: The choice of bladder management in people with SCI is influenced by a variety of factors and must be individualized. Health professionals should consider these factors when supporting patients in making decisions about their treatment options.
Study design: Qualitative study using individual in-depth interviews.

Matched MeSH terms: Urinary Bladder, Neurogenic/etiology*; Urinary Bladder, Neurogenic/psychology; Urinary Bladder, Neurogenic/therapy*
Fulltext More than meets the smile: facial muscle expression in children with Ochoa syndrome

Ganesan I, Thomas T

Med J Malaysia, 2011 Dec;66(5):507-9.
PMID: 22390114 MyJurnal

The Ochoa syndrome is the association of a non-neurogenic neurogenic bladder with abnormal facial muscle expression. Patients are at risk for renal failure due to obstructive uropathy. We report a family of three siblings, with an emphasis on the abnormalities in facial expression. Careful examination shows an unusual co-contraction of the orbicularis oculi and orbicularis oris muscles only when full facial expressions are exhibited, across a range of emotional or voluntary situations. This suggests a peripheral disorder in facial muscle control. Two thirds of patients have anal sphincter abnormalities. Aberrant organisation of the facial motor and urinary-anal sphincter nuclei may explain these symptoms.

Matched MeSH terms: Urinary Bladder, Neurogenic/physiopathology*
Factors associated with ultrasound diagnosed neurogenic bladder complications following spinal cord injury

Zamli AH, Mustafah NM, Sa'at N, Shaharom S

Med J Malaysia, 2020 11;75(6):642-648.
PMID: 33219171

INTRODUCTION: Neurogenic bladder (NB) is a recognized secondary medical impairment following spinal cord injury (SCI). Ultrasound (US) of the kidneys, ureters and bladder (KUB) has been recommended as a useful, non-invasive surveillance method with good diagnostic sensitivity. This study aims to understand US diagnosed NB complications and identify its associated factors.
METHODS: We enrolled all patients referred for SCI rehabilitation from 2012 to 2015 that fulfilled our study criteria. Data that were retrospectively reviewed included demographic and clinical characteristic data; and US KUB surveillance studies.
RESULTS: Out of 136 electronic medical records reviewed, 110 fulfilled the study criteria. The prevalence of NB in our study population was 80.9%. We found 22(20%) of the patients showed evidence of US diagnosed NB complications with the mean detection of 9.61±7.91 months following initial SCI. The reported NB complications were specific morphological changes in the bladder wall 8(36.4%); followed by unilateral/bilateral hydronephrosis 7(31.8%); bladder and/or renal calculi 5(22.7%); and mixed complication 2(9.1%) respectively. Half of the patients with NB complications had urodynamic diagnosis of neurogenic detrusor overactivity with/without evidence of detrusor sphincter dyssynergia. We found co-existing neurogenic bowel, presence of spasticity and mode of bladder management were significantly associated factors with US diagnosed NB complications (p<0.05), while spasticity was its predictor with adjusted Odds Ratio value of 3.93 (1.14, 13.56).
CONCLUSION: NB is a common secondary medical impairment in our SCI population. A proportion of them had US diagnosed NB complications. Co-existing neurogenic bowel, presence of spasticity and mode of bladder management were its associated factors; while spasticity was its predictor.

Matched MeSH terms: Urinary Bladder, Neurogenic
Fulltext Chronic Back Pain in a Young Female Patient: A Case of Ependymoma Originating from the Conus Medullaris

Asahar SF, Malek KA, Zohdi WNWM, Peter AB

Korean J Fam Med, 2020 Jan;41(1):68-72.
PMID: 31902199 DOI: 10.4082/kjfm.18.0157

We present the case of a 14-year-old Malay girl with an ependymoma of the conus medullaris who presented to multiple general practitioner clinics with a 24-month history of chronic low back pain. The pain was symptomatically managed as a simple musculoskeletal pain and sciatica. Further imaging to aid diagnosis was delayed until the appearance of severe pain with neurological deficits. Magnetic resonance imaging revealed an enhancing spinal mass at L1 through L3, and histopathological investigations confirmed the grade II ependymoma according to the World Health Organization classification. She underwent gross resection of the tumor. After the surgery, she developed neurogenic urinary bladder and bowel, which required intermittent self-catheterization, intermittent enema use, and intensive physical therapy.

Matched MeSH terms: Urinary Bladder, Neurogenic
Fulltext Bilateral Hydroureteronephrosis with a Hypertrophied, Trabeculated Urinary Bladder

Iqbal S, Raiz I, Faiz I

Malays J Med Sci, 2017 Mar;24(2):106-115.
PMID: 28894411 DOI: 10.21315/mjms2017.24.2.14

Bilateral hydroureteronephrosis involves the dilatation of the renal pelvis, calyces and ureter; it develops secondary to urinary tract obstruction and leads to a build-up of back pressure in the urinary tract, and it may lead to impairment of renal function and ultimately culminate in renal failure. Although clinically silent in most cases, it can be diagnosed as an incidental finding during evaluation of an unrelated cause. In a minority of patients, it presents with signs and symptoms. Renal calculus is the most common cause, but there are multiple non-calculus aetiologies, and they depend on age and sex. Pelviureteric junction obstruction, benign prostatic hypertrophy, urethral stricture, neurogenic bladder, retroperitoneal mass and bladder outlet obstruction are some of the frequent causes of hydroureteronephrosis in adults. The incidence of non-calculus hydronephrosis is more common in males than in females. Ultrasonography is the most important baseline investigation in the evaluation of patients with hydronephrosis. Here, we report a rarely seen case of bilateral hydroureteronephrosis associated with a hypertrophied, trabeculated bladder in an adult male cadaver, suspected to be due to a primary bladder neck obstruction, and analyse its various other causes, clinical presentations and outcomes.

Matched MeSH terms: Urinary Bladder, Neurogenic