Vaidyanathan Subramanian, Selmi Fahed, Abraham Kottarathil Abraham, Hughes Peter, Singh Gurpreet, Soni Bakul
Regional Spinal Injuries Centre, Southport and Formby District General Hospital, Town Lane, Southport, PR8 6PN, United Kingdom.
Patient Saf Surg. 2012 Sep 26;6(1):22. doi: 10.1186/1754-9493-6-22.
Condom catheters are indicated in spinal cord injury patients in whom intravesical pressures during storage and voiding are safe. Unmonitored use of penile sheath drainage can lead to serious complications.
A 32-year old, male person, sustained complete paraplegia at T-11 level in 1985. He had been using condom catheter. Eleven years after sustaining spinal injury, intravenous urography showed no radio-opaque calculus, normal appearances of kidneys, ureters and bladder. Blood urea and Creatinine were within reference range. A year later, urodynamics revealed detrusor pressure of 100 cm water when detrusor contraction was initiated by suprapubic tapping. This patient was advised intermittent catheterisation and take anti-cholinergic drug orally; but, he wished to continue penile sheath drainage. Nine years later, this patient developed bilateral hydronephrosis and renal failure. Indwelling urethral catheter drainage was established. Five months later, ultrasound examination of urinary tract revealed normal kidneys with no evidence of hydronephrosis.
Spinal cord injury patients with high intravesical pressure should not have penile sheath drainage as these patients are at risk for developing hydronephrosis and renal failure. Intermittent catheterisation along with antimuscarinic drug should be the preferred option for managing neuropathic bladder.
对于储尿期和排尿期膀胱内压力安全的脊髓损伤患者，可使用避孕套导尿管。未经监测使用阴茎套引流可导致严重并发症。
一名32岁男性，于1985年在T-11水平发生完全性截瘫。他一直在使用避孕套导尿管。脊髓损伤11年后，静脉肾盂造影显示无不透X线结石，肾脏、输尿管和膀胱外观正常。血尿素和肌酐在参考范围内。一年后，尿动力学检查显示，经耻骨上轻敲诱发逼尿肌收缩时，逼尿肌压力为100厘米水柱。建议该患者进行间歇性导尿并口服抗胆碱能药物；但他希望继续使用阴茎套引流。9年后，该患者出现双侧肾积水和肾衰竭。遂建立留置尿道导尿管引流。5个月后，泌尿系统超声检查显示肾脏正常，无肾积水迹象。
膀胱内压力高的脊髓损伤患者不应进行阴茎套引流，因为这些患者有发生肾积水和肾衰竭的风险。间歇性导尿联合抗毒蕈碱药物应是治疗神经源性膀胱的首选方法。
