Vaidyanathan S, Soni B M, Sett P, Singh G, Oo T, Hughes P L, Mansour P
Regional Spinal Injuries Centre, District General Hospital, Southport UK.
Spinal Cord. 2003 Dec;41(12):667-72. doi: 10.1038/sj.sc.3101519.
A retrospective study.
(1) To raise awareness of flawed trial of micturition (TOM) in male spinal cord injury (SCI) patients; and (2) to present guidelines for trial of voiding in male SCI patients.
Regional Spinal Injuries Centre, Southport, UK.
Trial of micturition in male SCI patients refers to discarding indwelling catheters and establishing them on balanced voiding with penile sheath drainage. We describe seven SCI patients, whose trial of micturition was flawed.
Two patients (C-6 and C-4 tetraplegia respectively) developed severe autonomic dysreflexia (headache, sweating, and increase in blood pressure) 2-3 h after removal of urethral catheter. A C-4 tetraplegic developed severe urinary infection after TOM. Four patients with tetraplegia started retaining increasing amounts of urine and developed urinary infections/autonomic dysreflexia/hydronephrosis 1-21 months after they were established on sheath drainage after TOM.
During TOM, patients with cervical SCI could develop autonomic dysreflexia, urinary infection, or hold progressively increasing volumes of residual urine. TOM should be guided by videourodynamics. SCI patients need alpha-blockers, and anticholinergics if voiding pressures are >40-50 cm H(2)O. If high urethral resistances are found, sphincterotomy and/or bladder neck incision will help the patients to void by triggering. SCI patients, who had undergone successful TOM, require meticulous follow-up including urodynamics. Intermittent catheterisation without adequate medications based on cystometrogram may be hazardous, and may result in upper tract damage. Facilities for supplementary catheterisation (three to four times a day) should be available in the community if a patient is unable to maintain complete, low-pressure, emptying of bladder.
一项回顾性研究。
（1）提高对男性脊髓损伤（SCI）患者排尿试验（TOM）存在缺陷的认识；（2）提出男性SCI患者排尿试验的指南。
英国南港地区脊髓损伤中心。
男性SCI患者的排尿试验是指拔除留置导尿管，并通过阴茎套引流建立平衡排尿。我们描述了7例排尿试验存在缺陷的SCI患者。
2例患者（分别为C-6和C-4四肢瘫）在拔除尿道导尿管后2 - 3小时出现严重自主神经反射异常（头痛、出汗和血压升高）。1例C-4四肢瘫患者在TOM后发生严重泌尿系统感染。4例四肢瘫患者在TOM后采用套引流排尿1 - 21个月后，开始出现尿量逐渐增多，并发生泌尿系统感染/自主神经反射异常/肾积水。
在TOM期间，颈髓SCI患者可能出现自主神经反射异常、泌尿系统感染或残余尿量逐渐增加。TOM应以视频尿动力学为指导。SCI患者需要使用α受体阻滞剂，如果排尿压力>40 - 50 cm H₂O，还需要使用抗胆碱能药物。如果发现尿道阻力高，括约肌切开术和/或膀胱颈切开术将有助于患者通过触发排尿。成功进行TOM的SCI患者需要进行细致的随访，包括尿动力学检查。基于膀胱压力图，在没有适当药物的情况下进行间歇性导尿可能是危险的，并可能导致上尿路损伤。如果患者无法维持膀胱完全、低压排空，社区应具备补充导尿（每天三到四次）的设施。
