Résumé
PURPOSE: The clinical and urodynamic effects of intravesical capsaicin, a neurotoxic substance causing a reversible suppression of unmyelinated C fiber afferent neuronal activity, were investigated for treatment of detrusor hyperreflexia in patients with spinal cord injury. MATERIALS AND METHODS: Capsaicin solution (2mM) dissolved in 30% alcohol was instilled intravesically in 7 men with detrusor hyperreflexia due to spinal cord injury. Effects on bladder function and subjective symptoms were evaluated before and after intravesical instillation of capsaicin. RESULTS: Bladder function was improved in all but 1 patient. The improvement was expressed as an increase from 108ml to 270ml in maximal bladder capacity and a decrease from 75cmH2O to 44cmH2O in maximal detrusor pressure. Four patients had subjective improvement following treatment and the effects lasted for 4 to 6 weeks. Immediately after capsaicin instillation the ice water test was negative in 2 patients. Autonomic dysreflexia was observed in 4 patients, suprapubic discomfort in 3 patients and gross hematuria in 1 patient. CONCLUSION: Intravesical capsaicin seems to be a promising method for treatment of detrusor hyperreflexia, but the general use of intravesical capsaicin was limited due to side effects.
Sujets)
Humains , Mâle , Administration par voie vésicale , Dysréflexie autonome , Capsaïcine , Hématurie , Glace , Neurofibres non-myélinisées , Neurones afférents , Réflexes anormaux , Traumatismes de la moelle épinière , Vessie urinaire , Urodynamique , EauRésumé
PURPOSE: Nocturia and enuresis are common voiding problems in spinal cord injured patients despite a variety of management. The purpose of this study is to determine the efficacy of desmopressin, a synthetic analogue of antidiuretic mono, as an alternative treatment in the management of spinal cord injured(SCI) patients with neurogenic bladder dysfunction unresponsive to conventional therapy. MATERIALS AND METHODS: Fourteen SCI patients with nocturia or enuresis were included in this study. The patients received 10microgram desmopressin intranasally at bedtime once every 24 hours. RESULTS: There was a significant decrease in nocturnal urinary volume, frequency of nocturia and nocturnal enuresis during nighttime after desmopressin administration. Two patients stopped desmopressin because of side effects. 8 of 12 patients improved with desmopressin and the remainder had no effect. There was no serum abnormality, although there were side effects in three cases, such as gastro-intestinal trouble, chest discomfort or nasal congestion. CONCLUSIONS: Desmopressin is safe and effective in the management of nocturia or enuresis due to neurogenic bladder dysfunction in selected SCI patients.
Sujets)
Humains , Desmopressine , Énurésie , Oestrogènes conjugués (USP) , Nycturie , Énurésie nocturne , Traumatismes de la moelle épinière , Moelle spinale , Thorax , Vessie neurologiqueRésumé
We report a case of prostatic abscess in a 46-year old man with chronic myelocytic leukemia. Preoperative transrectal ultrasonography and computerized tomography confirmed the diagnosis of prostatic abscess, which was treated with pus drainage via transurethral resection of prostate and broad-spectrum antibiotics.
Sujets)
Humains , Adulte d'âge moyen , Abcès , Antibactériens , Diagnostic , Drainage , Leucémie myéloïde chronique BCR-ABL positive , Suppuration , Résection transuréthrale de prostate , ÉchographieRésumé
Long-term indwelling catheters constitute a risk factor for the development of bladder malignancy. Our study was designed to compare the incidence of bladder cancer and histological changes in the urinary bladder of spinal cord injury patients who had been catheterized for more than 11 years (group 1) and less than 10 years (group 2). Mean duration of catheterization was 17.7 years (range 11-38 years) and 6.5 years (range 2-10 years), respectively in both groups. Our study was performed by cystoscopic evaluation and random bladder biopsy in 23 patients in group 1 and 25 patients in group 2 followed at the Korea Veterans Hospital. The follow-up interval, mechanism, level and degree of injury for both groups were similar. The suprapubic cystostomy was the most common voiding method in both groups (73.9% and 60.0%, respectively). Transitional cell carcinoma in one patient and adenocarcinoma in two patients were found in group 1 and transitional cell carcinoma in one patient was found in group 2. Two patients in group 1 showed squamous metaplasia. 18 patients in group 1 and 24 patients in group 2 showed chronic cystitis. Microscopic hematuria (greater than 2-4 RBC/HPF) was present in all patients. IVPs demonstrated no filling defect of upper tracts in all patients. Overall, the incidences of bladder cancer were 13.0% (3/23) in group 1 and 4.0% (1/25) in group 2. But there was no significant difference in the incidence of bladder cancer between both groups (p=0.279). We suggest that any spinal cord injury patient with hematuria needs a complete bladder evaluation and should undergo cystoscopy and random bladder biopsy.
Sujets)
Humains , Adénocarcinome , Biopsie , Carcinome transitionnel , Cathétérisme , Cathéters , Cathéters à demeure , Cystite , Cystoscopie , Cystostomie , Études de suivi , Hématurie , Hôpitaux des anciens combattants , Incidence , Corée , Métaplasie , Facteurs de risque , Traumatismes de la moelle épinière , Moelle spinale , Tumeurs de la vessie urinaire , Vessie urinaireRésumé
337 spinal cord injured patients had been followed up for urologic management in Korea Veterans Hospital. 106 spinal cord injured patients, admitted due to urologic complications from 1990 to 1995, were analyzed. The level of cord injury was cervical in 26, thoracic in 63 and lumbar in 17 patients. The voiding method was suprapubic cystostomy in 32, clean intermittent catheterization in 27, self-voiding in 25, condom catheter in 14, urethral catheter in 6 and others in 2 patients. The common urologic complications were acute pyelonephritis, bladder stone, epididymitis, vesicoureteral reflux, low vesical compliance, autonomic dysreflexia and bladder tumor. Medical treatments for urologic complications were performed for 79 cases (46%) and surgical treatments for 92 cases (54%) We conclude that periodic urologic follow-up will be needed for early detection and management of urologic complications due to spinal cord injury.