Weld K J, Dmochowski R R
Department of Urology, University of Tennessee, Memphis, USA.
J Urol. 2000 Mar;163(3):768-72.
The optimal method of bladder management in spinal cord injured patients remains controversial. We investigated the association of type of bladder management with urological complications in these patients.
We retrospectively reviewed the medical records, upper tract imaging and video urodynamics of 316 posttraumatic spinal cord injured patients. Mean followup plus or minus standard deviation since injury was 18.3+/-12.4 years. Patients were categorized according to bladder management method, including chronic urethral catheterization, clean intermittent catheterization, spontaneous voiding and suprapubic catheterization in 114, 92, 74 and 36, respectively. No significant differences in patient age at injury, followup interval, or level, completeness or mechanism of injury were noted among bladder management method groups. Infection, stone disease, urethral complications and radiographic abnormalities were recorded.
Of the 398 complications recorded 236 developed in 61 (53.5%) patients on chronic urethral catheterization, 57 in 25 (27.2%) on clean intermittent catheterization, 57 in 24 (32.4%) who voided spontaneously and 48 in 16 (44.4%) on suprapubic catheterization. The intermittent catheterization group had statistically significant lower complication rates compared with the urethral catheterization group and no significantly higher complication rates relative to all other management methods for each type of complication studied. The percent of patients with complications was greater in the chronic urethral catheterization group only 5 years after injury, while the percent in all other management groups remained similar up to 15 years after injury.
Clean intermittent catheterization is the safest bladder management method for spinal cord injured patients in terms of urological complications. Inappropriate selection of a bladder management method not only adversely affects patient quality of life, but also has a significant detrimental impact on the economic status of the health care system.
脊髓损伤患者膀胱管理的最佳方法仍存在争议。我们研究了这些患者膀胱管理类型与泌尿系统并发症之间的关联。
我们回顾性分析了316例创伤后脊髓损伤患者的病历、上尿路影像学检查和视频尿动力学检查结果。自受伤以来的平均随访时间加减标准差为18.3±12.4年。患者根据膀胱管理方法进行分类，分别为长期尿道留置导尿、清洁间歇性导尿、自主排尿和耻骨上膀胱造瘘，各有114例、92例、74例和36例。膀胱管理方法组在受伤时的患者年龄、随访间隔、损伤平面、损伤程度或损伤机制方面无显著差异。记录感染、结石病、尿道并发症和影像学异常情况。
在记录的398例并发症中，长期尿道留置导尿的61例（53.5%）患者出现236例并发症，清洁间歇性导尿的25例（27.2%）患者出现57例并发症，自主排尿的24例（32.4%）患者出现57例并发症，耻骨上膀胱造瘘的16例（44.4%）患者出现48例并发症。与尿道留置导尿组相比，间歇性导尿组的并发症发生率在统计学上显著较低，且相对于所研究的每种并发症的所有其他管理方法，其并发症发生率没有显著更高。仅在受伤5年后，长期尿道留置导尿组出现并发症的患者百分比更高，而所有其他管理组在受伤后15年内的百分比保持相似。
就泌尿系统并发症而言，清洁间歇性导尿是脊髓损伤患者最安全的膀胱管理方法。膀胱管理方法选择不当不仅会对患者生活质量产生不利影响，还会对医疗保健系统的经济状况产生重大不利影响。
