Neurol. praxi. 2009;10(3):160-164

Taking care of urine and stool passage in patients with complete spinal cord lesion

MUDr. Martin Sutorý, CSc, prof. MUDr. Peter Wendsche, CSc

Klinika Traumatologie LF MU se Spinální jednotkou v Úrazové nemocnici v Brně

Bladder atonia and areflexia are functional consequences of spinal shock following SCI. Sphincters are inactive, voiding is not possible.

The bladder is distended. During this acute phase the therapeutic aim occurs in ensuring of the urine derivation preventing complications.

Following procedures are used: permanent indwelling catheter, suprapubic drainage, intermittent cathe terization, reflex voiding

by bladder tapping and suprapubic manual pressure. First days after injury on the ICU, a permanent indwelling catheter is used, later

on changed to suprapubic drainage. It is recommended to change to intermittent catheterization as early as possible. Related to the

level of injury the catheterization by themselves is trained for. Presence of urine infection can influence these algorithms. An adequate

therapy of urine infection prevents bladder stone formation. Basic diagnostic for detrusor-sphincter dyssynergy during the chronically

phase is the video-urodynamical assessment. Therapy is difficult, it occurs in a sufficient derivation. Pharmacological therapy mainly

is focused to reduce the hydrostatic pressure in the urine system. Beside suprapubic epicystostomy surgical procedures are described.

Those procedures support continence or provide for permanent incontinence (urinal).

Keywords: bladder atonia, urine derivation, sterile intermittent catheterization, detrusor-sphinteric dyssynergy, video-urodynamic assessment.

Published: July 1, 2009  Show citation