NeuroRehabilitation - Volume 4, issue 4

Article Type: Other

DOI: 10.3233/NRE-1994-4401

Citation: NeuroRehabilitation, vol. 4, no. 4, pp. iv-iv, 1994

Authors: Linsenmeyer, Todd

Article Type: Introduction

DOI: 10.3233/NRE-1994-4402

Citation: NeuroRehabilitation, vol. 4, no. 4, pp. vi-vi, 1994

Authors: Gribble, Marie J.

Article Type: Research Article

Abstract: Quantitative urine cultures are used to identify individuals in whom urine in the bladder is not sterile, that is, those who have bacteriuria. In people with spinal cord injury the criteria which best distinguish specimen contamination from bacteriuria have been established, and are lower than the traditional ≥1055 CFU/ml criterion. Bacteriuria mayor may not be symptomatic, and the benefits of treatment mayor may not outweigh the risks. Abnormal levels of pyuria are present in the great majority of spinal cord injured people who have indwelling catheters or who use intermittent catheterization. In the latter group, catheter urine is …not homogeneous, and levels of pyuria are highest in the terminal fraction of catheter urine. Absence of pyuria is a good indicator of absence of high count gram negative bacteriuria, but pyuria may be present in the absence of bacteriuria in this population. No methods suitable for routine clinical use are currently available to localize the site of urinary infection in this population. Frequently recurrent or persistent bacteriuria is extremely common in people with spinal cord injury. Bacteriuria is most often asymptomatic, yet is clearly significant in that it is responsible for measurable short-term and long-term morbidity. However, at present, quantitative urine cultures and tests for pyuria cannot, by themselves, be used to identify spinal cord injured persons who will reliably benefit from treatment for bacteriuria. Show more

Keywords: Bacteriuria, neurogenic bladder, urinary tract infection, diagnosis, spinal cord injury

DOI: 10.3233/NRE-1994-4403

Citation: NeuroRehabilitation, vol. 4, no. 4, pp. 205-213, 1994

Authors: Montgomerie, John Z.

Article Type: Research Article

Abstract: Despite improvements in the techniques to drain the urinary bladder in patients with spinal cord injury (SCI), urinary tract infection (UTI) remains one of the most common complications of SCI. Despite many studies of the management of UTIs, differences of opinion remain. This has resulted from the use of different definitions of UTI, including the definitions of “significant” bacteriuria, “asymptomatic” bacteriuria, the inclusion (or exclusion) of “soft” symptoms, evidence of few complications from the infection and other risks of infection. The need to treat patients with high fever who may have bacteremia and patients with symptoms is clear. Broad coverage …may be necessary until the results of culture are available because of the frequent presence of resistant bacteria colonizing the perineum or bowel. Eradication of bacteriuria is not a reasonable goal in many patients with indwelling catheters. The treatment of patients with asymptomatic bacteriuria (those patients without symptoms or pyuria) remains controversial. Asymptomatic bacteriuria is often treated in recently injured inpatients and those that have their first infection and is not treated in persons in whom asymptomatic bacteriuria is detected more than one year following the injury. Selection of the antibiotics depends on the symptoms of UTI, but at the risk of developing colonization of the urinary tract, perineum, or bowel with resistant gram-negative bacilli. Show more

Keywords: Urinary tract infection (UTI), treatment, spinal cord injury (SCI), antibiotics and prophylaxis

DOI: 10.3233/NRE-1994-4404

Citation: NeuroRehabilitation, vol. 4, no. 4, pp. 214-221, 1994

Authors: National Institute on Disability and Rehabilitation Research

Article Type: Research Article

Abstract: The Urinary Tract Infection Consensus Conference brought together researchers, clinicians, and consumers to arrive at consensus on the best practices for preventing and treating urinary tract infections in people with spinal cord injuries; the risk factors and diagnostic studies that should be done; indications for antibiotic use; appropriate follow-up management; and needed future research. Urinary tract infection (UTI) was defined as bacteriuria (≥102 bacteria/ml of urine) with tissue invasion and resultant tissue response with signs and/or symptoms. Asymptomatic bacteriuria represents colonization of the urinary tract without symptoms or signs. Risk factors include: overdistension of bladder, vesicoureteral reflux, high-pressure …voiding, large postvoid residuals, presence of stones in urinary tract, and outlet obstruction. Possible physiologic/structural, behavioral and demographic risk factors were identified also. Indwelling catheterization, including suprapubic, and urinary diversion are the drainage methods most likely to lead to persistent bacteriuria. Infection risk is reduced with intermittent catheterization, but more severely disabled people who require catheterization by others are at greater risk for UTIs. Clean self-intermittent catheterization does not pose a greater risk of infection than sterile self-intermittent catheterization and is much more economic. However, care must be given to proper cleansing of reusable catheters. Quantitative urine-culture criteria for the diagnosis of bacteriuria include: catheter specimens from individuals on intermittent catheterization— ≥102 cfu/ml; clean-void specimens from catheter-free males using condom collection devices— ≥104 cfu/ml; specimens from indwelling catheters-any detectable concentration. Dip stick screening tests may offer promise as an early warning system of UTI since they can be self-administered. Symptomatic UTI should be treated with antibiotics for 7–14 days. Longer courses have not been beneficial. In patients with symptomatic UTIs, it is not necessary to wait for the results of cultures before starting treatment. Asymptomatic bacteriuria need not be treated with antibiotics. There is little evidence presently to support the use of antibiotics to prevent infections. Following a recent episode of febrile UTI, possible contributing prior events should be reviewed. The upper tracts should be evaluated (imaging studies) to identify possible abnormalities. A common concern among people with spinal cord injuries is that physicians will alter bladder management programs without regard to lifestyle needs. Social/vocational flexibility may be more important to them than a state-of the-art bladder management program. Future research should focus on obtaining more representative samples and investigate psycho-social-vocational implications as well as additional clinical-medical factors. Show more

Keywords: Urinary tract infection, spinal cord injury, catheterization

DOI: 10.3233/NRE-1994-4405

Citation: NeuroRehabilitation, vol. 4, no. 4, pp. 222-236, 1994

Authors: Alverzo, Joan Palasz | Jacalan, Cecilia L.

Article Type: Research Article

Abstract: Voiding dysfunctions affect a large number of patients in the rehabilitation setting. Following an assessment of the patient in which a diagnosis is established, an array of non pharmacologic treatment options need to be considered. Behavioral as well as supportive techniques may be used in various combinations to individualize a successful program for the patient. This article reviews each technique including indications and special considerations in order to assist in developing a plan for managing urinary dysfunction from a nursing perspective.

Keywords: Urinary incontinence, neurogenic bladder, nursing management, bladder management, voiding dysfunction

DOI: 10.3233/NRE-1994-4406

Citation: NeuroRehabilitation, vol. 4, no. 4, pp. 237-244, 1994

Authors: Jackson, Amie B.

Article Type: Research Article

Abstract: Removal of an indwelling catheter and the initiation of intermittent catheterization (IC) has become a standard urological goal over the past decades. While realistic for men it is more difficult for women, mainly due to their anatomical differences and lack of development of a satisfactory external collection device. Thus, the evaluation for IC as a bladder management method must involve a different approach for women with spinal cord injury (SCI) than their male counterparts. Key components of the evaluation include the woman's functional abilities, attendant care, motivation, neurological bladder type (i.e., reflexive versus areflexive) along with maintenance of social continence …and stable renal function. It has been shown that women tend to have less urological complications and renal deterioration than men, no matter what method of bladder management they we. Advances in urological pharmacology, diversionary surgeries and neural blocks have greatly contributed to successful bladder manipulation for self-IC. Show more

Keywords: Female, bladder management, intermittent catheterization, spinal cord injury

DOI: 10.3233/NRE-1994-4407

Citation: NeuroRehabilitation, vol. 4, no. 4, pp. 245-248, 1994

Authors: Perkash, Inder

Article Type: Research Article

Abstract: We report here a new technique of external sphincterotomy in 30 spinal cord injury patients. Instead of electrocautery, the contact sapphire chisel probe firing Nd:YAG laser was used to ablate the external urethral sphincter. The major advantages of this procedure over electrocautery are (1) significantly decreased blood loss; (2) shorter, less morbid postoperative course and shorter hospital stay; and (3) durable results. Long-term follow-up of these patients is currently underway.

Keywords: Neurogenic bladder, TUR surgery, spinal cord injury, laser surgery, bladder outlet obstruction

DOI: 10.3233/NRE-1994-4408

Citation: NeuroRehabilitation, vol. 4, no. 4, pp. 249-254, 1994

Authors: Campagnolo, Denise I. | Linsenmeyer, Todd A. | Jacalan, Cecilia L. | Pak, Nanwai A. | Averill, Allison M.

Article Type: Research Article

Abstract: There is little reported in the literature describing the prevalence of voiding dysfunction after brain injury. A prospective study was conducted, 54 consecutive admissions to our brain injury unit from September 1992 through January 1993 were screened for signs and symptoms of voiding dysfunction. Signs and symptoms were noted in 24 patients (44.4%). There was no statistically significant difference in symptom prevalence based on age, sex, hemisphere (right or left) injured, or presence or absence of a frontal lobe injury. Those functioning at a lower cognitive level (Rancho Los Amigos Scale VI or less) had a higher symptom prevalence than …the VII–VIII group (p = 0.004, Chi Square Test). Show more

Keywords: Urinary incontinence, brain injuries, urination disorders, cognition disorders

DOI: 10.3233/NRE-1994-4409

Citation: NeuroRehabilitation, vol. 4, no. 4, pp. 255-258, 1994

Authors: Linsenmeyer, Todd A. | Anderson, Rodney U. | Lawton, Malcom B. | Berrly, Michael H.

Article Type: Research Article

Abstract: This is the first prospective study evaluating both urinary complaints and bladder physiology following acute cerebrovascular accidents (CVAs). Consecutive patients with acute CVAs were entered into this study. Voiding histories and urodynamics were performed 1–2 weeks post-CVA, 1–2 months post-CVA, 4–10 months post-CVA, and 5 months later (9–15 months post-CVA). Previous studies have focused on urinary incontinence and reported that this problem resolves in the majority of patients. This study also found that urinary incontinence resolved. However, other urinary complaints, such as urinary frequency and nocturia, which also had a significant adverse impact on the individuals' lifestyle, continued to persist. …Urodynamic studies at one year revealed that uninhibited bladder contractions persisted despite resolution of incontinence. There was no obvious relationship between the location of the CVA in the right hemisphere and those who did or did not develop urologic symptoms. Show more

Keywords: Urinary incontinence, cerebrovascular accident, urodynamics

DOI: 10.3233/NRE-1994-4410

Citation: NeuroRehabilitation, vol. 4, no. 4, pp. 259-265, 1994