• Users Online: 553
  • Print this page
  • Email this page
REVIEW ARTICLE
Year : 2023  |  Volume : 34  |  Issue : 1  |  Page : 10-17

Clinical guidelines of patient-centered bladder management of neurogenic lower urinary tract dysfunction due to chronic spinal cord injury - Part 2: Conservative and minimally invasive treatment


1 Department of Urology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
2 Division of Urology, Department of Surgery, Yuanlin Christian Hospital, Changhua, Taiwan
3 Department of Urology, Chung Shan Medical University Hospital and School of Medicine, Chung Shan Medical University, Taichung, Taiwan
4 Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan
5 Department of Urology, En Chu Kong Hospital, New Taipei City; Department of Biomedical Engineering, Chung Yuan Christian University, Chungli, Taiwan
6 Department of Urology, National Taiwan University Hospital, and College of Medicine, National Taiwan University, Taipei, Taiwan
7 Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Linkou Branch; School of Medicine, Chang Gung University, Taoyuan, Taiwan
8 Division of Urology, Department of Surgery, Chi Mei Medical Center, Tainan, Taiwan
9 Department of Urology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University, College of Medicine, Kaohsiung, Taiwan
10 Division of Urology, Department of Surgery, Taiwan Adventist Hospital, Taipei, Taiwan
11 Department of Urology, Taipei City Hospital, Yangming Branch, Taipei, Taiwan
12 Department of Urology, Cardinal Tien Hospital, College of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan
13 Department of Urology, En Chu Kong Hospital, New Taipei City, Taiwan
14 Division of Urology, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
15 Department of Urology, Kaohsiung Municipal Siao Gang Hospital, Kaohsiung, Taiwan
16 Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, and Tzu Chi University, Hualien, Taiwan

Correspondence Address:
Hann-Chorng Kuo
Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, 707, Section 3, Chung-Yang Road, Hualien 97002
Taiwan
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/UROS.UROS_116_22

Rights and Permissions

Bladder management of chronic spinal cord injured (SCI) patients usually starts with conservative treatment or minimally invasive procedures. This article reports the current evidence and expert opinions on the patient-centered bladder management of neurogenic lower urinary tract dysfunction (NLUTD) among patients with chronic SCI in Taiwan. We evaluated the role of clean intermittent catheterization (CIC), cystostomy, medical treatment, and minimally invasive therapy for treating urinary incontinence and voiding dysfunction in patients with chronic SCI. The bladder management for chronic SCI patients should be individualized. A balance between upper urinary tract protection and life quality improvement should be considered. Hand dexterity, abdominal muscle power, bladder sensation, and degree of urethral sphincter dyssynergia might affect the improvement of voiding efficiency and NLUTD. Intradetrusor Botulinum Toxin Type A (BoNT-A) injection has been proven to effectively treat neurogenic detrusor overactivity in SCI patients. However, CIC is still required in some patients after treatment. The urethral sphincter BoNT-ABoNT-A injection can effectively relax the dyssynergic sphincter; however, exacerbation of urinary incontinence usually limits its application in SCI patients. Repeat BoNT-ABoNT-A injection is necessary to maintain the therapeutic efficacy; therefore, some SCI patients might discontinue the treatment and convert to a permanent bladder management by surgical intervention. Identification of high-risk SCI patients is important to prevent renal functional deterioration in those with chronic SCI-NLUTD. Avoiding renal function deterioration and improving the quality of life of SCI patients with NLUTD are the most important aspects of treatment. Annual active surveillance of bladder and renal function is necessary.


[FULL TEXT] [PDF]*
Print this article     Email this article
 Next article
 Previous article
 Table of Contents

 Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
 Citation Manager
 Access Statistics
 Reader Comments
 Email Alert *
 Add to My List *
 * Requires registration (Free)
 

 Article Access Statistics
    Viewed2201    
    Printed114    
    Emailed0    
    PDF Downloaded210    
    Comments [Add]    

Recommend this journal