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Neurogenic Bladder/Spinal Cord Injury

ASYMPTOMATIC BACTERIURIA
A prospective 2020 study of 317 patients (106 women and 211 men) found that symptomatic UTI will develop in about 1 of 5 patients with asymptomatic baceriuria in the next year. (5)

UDS
After spinal cord injury, 2/3 have unfavorable urodynamics within first 40 days. (3)  

CIC
By 5 years, 1/2 of SCI patients on CIC have opted for indwelling catheters.  By 20 years, only 20% are performing CIC. (4) Those most likely to be successful with long term CIC are thin paraplegic men. 

SURGERY
Augmentation cystoplasty (AC) indications include:
  1. High bladder storage pressure (>40 cm H20)
  2. Socially unacceptable UI due to detrusor overactivity or decreased bladder compliance
  3. High grade and/or low pressure VUR with UUT deterioration
  4. Infective and inflammatory disorders such as tuberculous bladder contracture
  5. significantly decreased serum Cr after indwelling urethral catheterization in patiehts with chronci renal failure (Cr >1.5) (1)

Sigmoid colon is first choice with colon second for AC (1). Cr drop after foley insertion suggests patient will be more likely to respond to AC. (2) Ureteral reimplantation with AC may be beneficial for patients with low pressure or high grade VUR, UVJ obstruction and/or stenosis, or uretral tortuosity and adhesion, and/or severe UUT dilatation (1).

​
  1. Wang, Zhaoxia, and Limin Liao. "Effectiveness and Complications of Augmentation Cystoplasty with or without Nonrefluxing Ureteral Reimplantation in Patients with Bladder Dysfunction: A Single Center 11-Year Experience." The Journal of urology 199.1 (2018): 200-205.
  2. Zhang, Fan, and Limin Liao. "Sigmoidocolocystoplasty with ureteral reimplantation for treatment of neurogenic bladder." Urology 80.2 (2012): 440-445.
  3. Bywater, Mirjam, et al. "Detrusor acontractility after acute spinal cord injury—myth or reality?." The Journal of urology199.6 (2018): 1565-1570.
  4. Cameron, A. P., Wallner, L. P., Tate, D. G., Sarma, A. V., Rodriguez, G. M., & Clemens, J. Q. (2010). Bladder Management After Spinal Cord Injury in the United States 1972 to 2005. The Journal of Urology, 184(1), 213–217.​
  5. Tornic, Jure, et al. “The Challenge of Asymptomatic Bacteriuria and Symptomatic Urinary Tract Infections in Patients with Neurogenic Lower Urinary Tract Dysfunction.” The Journal of Urology, vol. 203, no. 3, 2020, pp. 579–584.

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