Konstantinidis Charalampos, Karafotias Achileas, Eleftheropoulos Ioannis, Delakas Dimitrios
Urology & Neuro-urology Unit, National Rehabilitation Center, Athens, Greece.
2Urology Department, General hospital "Asklepieio Voulas", Athens, Greece.
Spinal Cord Ser Cases. 2019 Sep 23;5:78. doi: 10.1038/s41394-019-0224-6. eCollection 2019.
Spinal cord injury (SCI), specifically suprasacral SCI, results in high intravesical pressures, elevated post-void residual and urinary incontinence which are all risk factors for urinary tract infections (UTIs). The management of UTIs usually is conservative medical antibiotic treatment. However, recurrent UTIs in the SCI patient population warrant further investigation. The method of urinary drainage (intermittent or indwelling urinary catheters, urinary diversion) and untreated complications of NLUTD (vesicoureteral reflux, stone formation, chronic incomplete emptying of the bladder) are risk factors for recurrent UTIs (rUTIs). Removal of these UTI risk factors and improving urinary drainage are goals of urologic management; however, when conservative interventions do not succeed, surgery may be a viable solution in select cases of rUTIs.
We present a case of complicated persisting rUTIs and associated urethral discharge in a middle-aged SCI male who manages his bladder with intermittent catheterization (IC). We detail the evaluation and management approach that leads to an eventual transurethral prostatectomy (TURP) as a final solution for his rUTIs. Fortunately, the surgical intervention was successful, and the patient is free of UTIs after 4 years of follow-up.
In SCI male patients with rUTIs and suspected chronic prostatitis, TURP may be a valuable treatment option once all predisposing factors have been remediated.
脊髓损伤（SCI），特别是骶上脊髓损伤，会导致膀胱内压力升高、排尿后残余尿量增加和尿失禁，这些都是尿路感染（UTIs）的危险因素。尿路感染的治疗通常采用保守的抗生素药物治疗。然而，脊髓损伤患者群体中复发性尿路感染值得进一步研究。尿液引流方法（间歇性或留置导尿管、尿流改道）以及未治疗的下尿路功能障碍并发症（膀胱输尿管反流、结石形成、膀胱慢性排空不全）是复发性尿路感染（rUTIs）的危险因素。消除这些尿路感染危险因素并改善尿液引流是泌尿外科治疗的目标；然而，当保守干预措施失败时，手术可能是某些复发性尿路感染病例的可行解决方案。
我们报告一例中年脊髓损伤男性患者，该患者通过间歇性导尿（IC）管理膀胱，患有复杂的持续性复发性尿路感染并伴有尿道分泌物。我们详细介绍了评估和管理方法，最终采用经尿道前列腺切除术（TURP）作为其复发性尿路感染的最终解决方案。幸运的是，手术干预成功，患者在随访4年后未再发生尿路感染。
在患有复发性尿路感染且怀疑患有慢性前列腺炎的脊髓损伤男性患者中，一旦所有诱发因素得到纠正，经尿道前列腺切除术可能是一种有价值的治疗选择。
