Title: Rehabilitation Outcome in Reflex Bladder in Spinal Cord Injury Patients – A Comparative Study of Early & Late Intervention
Authors: Mohan Raj M, George Joseph N, Vasudevan T.K, Sreedevi Menon P
DOI: https://dx.doi.org/10.18535/jmscr/v5i2.58
Abstract
Background: Renal failure and other urinary tract complications were the major causes of mortality in patients with spinal cord injury. Effective early rehabilitation will prevent the onset of complications, reduce the mortality, morbidity and improve the quality of life too.
Objectives
1. To compare the effects of early and late rehabilitation on the functional outcome of reflex bladder in spinal cord injury patients.
2. To study the associated demographic factors.
Settings and Design: Randomized control trial study conducted in a tertiary level multispecialty hospital.
Materials and Methods: 44 patients with traumatic spinal cord injury participated in this study. These patients are divided into 2 groups. Group A before 3 months and group B after 6 months. All patients were given same urological rehabilitation. Patients are then reassessed after 3 months and 6 months by clinical, laboratory and Ultrasound KUB examinations.
Results: The main age group affected are between 31-40 yrs and males are more affected. There is a decrease in residual urine volume and recurrent symptomatic bacteriuria after treatment in both groups, more in group A. Significant increase in bladder capacity in noted in group A. Raised renal function tests was seen in group B only. Significant bladder wall thickening and hydronephrosis were observed mainly in group A.
Conclusion: Early urological rehabilitation optimizes the bladder functions and prevents the complications.
Keywords: Reflex bladder, residual urine volume, urological rehabilitation.
References
1. Perkash I: Management of neurogenic dysfunction of bladder and bowel. In Kottke FJ, Stillwell GK, LehmannlF(eds): Krusen ‘s Hand book of Physical Medicine and Rehabilitation, 3rd ed pp 724-745 Philadelphia, WB Saunders. 1982.
2. Joachim L Opitz. Gudni Thorsreinsson, Ann H Schutt, David M Barrett, Patricka K Olson -Joel A Dehisa - Rehabilitation Medicine: Principles And Practice, 492 515.
3. Barton CH, Vaziri ND, Gordon S et a! Renal pathology in end stage renal disease associated with paraplegia 22:31-41,1984.
4. Shirley McCluer - Management of Urinary Tract Infections in Spinal Cord Injuries- Fact Sheet 22: - Spinal Cord Commission. Date: March 8, 1994.
5. Lapides J, Diokno AC, Silber SJ, et al: Clean, intermittent self-catheterization in the treatment of urinary tract disease, Urol 107(3):458-461, 1972.
6. Cardenas DD, Kelly E, Mayo ME: Manual stimulation of reflex voiding after spinal cord injury, Arch Phys Med Rehabil 66(7):459-462, 1985.
7. Diana D Cardenas and Michael E Mayo - Physical Medicine & Rehabilitation - Randall L Bradom, Physical Medicine & Rehabilitation, South Asia edition 3, pp. 617- 635.
8. MA Salam - Tolterodine tartate - Principles of Urology Second edition, Volume 1; page 404.
9. MacDonald R, Monga M, Fink H, et al: Neurotoxin treatments for urinary incontinence in subjects with spinal cord injury or multiple sclerosis: a systematic review of effectiveness and adverse effects, J Spinal cord Med 31:157-165, 2008.
10. Hodgkinson CP, Drukker BH: Infravesical nerve resection for detrusor dyssynergia: The Ingelman- Sundberg operation. Acta Obstet Gynecol Scand56:401-408, 1977
11. Scheihammer PF, Hackler RH, Bunts RC, External sphincterotomy: An evaluation of 150 patients with neurogenic bladder. J Urol 110: 199-202, 1973.
12. Linder A.,Leach GE Raz Augmentation cystoplasty in the treatment neurogenic bladder dysfunction. J Urol 129;491-493,1983.
13. Lange; Smith’s General Urology- Emil Tanagho, l6th edition.2004, pp.435- 451.
14. National Institute on Disability and Reha-bilitation Research Consensus Statement: The prevention and management of urinary tract infections among people with spinal cord injuries. Jam Paraplegia Soc 1992; 15; 194- 204.
15. Griffith DF: Infection induced stones. In Coe FL (ed): Nephrolithiasis: pathogenesis and treatment, pp203-228 Chicago, Year Book Medical Publishers, 1978.