Hydronephrosis and renal failure following inadequate management of neuropathic bladder in a patient with spinal cord injury: Case report of a preventable complication

Autor: Subramanian Vaidyanathan, Gurpreet Singh, Kottarathil Abraham Abraham, Peter L Hughes, Fahed Selmi, Bakul M Soni
Jazyk: angličtina
Rok vydání: 2012
Předmět:
Zdroj: Patient Safety in Surgery
Patient Safety in Surgery, Vol 6, Iss 1, p 22 (2012)
ISSN: 1754-9493
Popis: Background: 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. Case report: 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. Conclusion: 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. Background Hydronephrosis in persons with spinal cord injury is associated with the neural damage, urinary infection and back pressure; the importance of each factor varying considerably with the individual. [1] The appearance of the hydronephrosis associated with neurogenic bladder dysfunction has been attributed to the increased intravesical pressure which forces the ureter to pump urine into the bladder at increasingly higher pressures until a state of hydronephrosis is reached. [2]. Rosen and associates [3] recommend that all spinal cord injury patients functioning in the catheter-free state must be followed regularly at no longer than 6-month intervals. Changes in the resistance to the outflow of urine may occur at any time, even years after injury. When an event occurs, such as increased spasticity, which may be associated with increased sphincter resistance, the patient should be checked for evidence of outflow obstruction. Condom catheters are convenient to spinal cord injury patients and their carers, but they can lead to problems and complications, sometimes severe. Newman and Price [4] found bacteriuria in more than 50% of patients using a condom catheter. Lesions of the penis can be secondary to mechanical damage to the skin from an excessively tight condom worn for a prolonged time. Another common cause of skin lesions is allergy to the material of the condom, usually to latex. Wyndaele and associates [5] concluded that a condom catheter may be indicated in male spinal cord injury patients with urinary incontinence provided that they have no penile lesion and that intravesical pressures during storage and voiding are urodynamically safe. We report a paraplegic
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