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Medical Rehabilitation - quarterly journal
Volume 11 year 2007, Issue number 2
Contemporary diagnostic methods of the urinary system in patients after spinal injury with subsequent neurological deficits: Diagnostics of the lower urinary tract
Współczesne metody oceny układu wydalniczego u osób po urazie kręgosłupa powikłanym zaburzeniami neurologicznymi - diagnostyka dolnych dróg moczowych
Piotr Tederko, Marek Krasuski, Jerzy Kiwerski
Department of Rehabilitation ,Medical University of Warsaw, Poland
Rehabilitation Centre, Konstancin, Poland
Received: 30.05.2007; accepted 21.08.2007
Key words
spine, injury, complications, diagnostics, neurogenic bladder, lower urinary tract
Abstract
Introduction: Spinal injury with neurological deficit usually results in a neurogenic bladder disorder. The problem may range from total lack of micturition during the spinal shock phase to various forms of detrusor-sphincter dyssynergia. Typical consequences include increased intravesical pressure, inability to effectively empty the bladder, increased risk of vesico-ureteral reflux, infection, bladder or kidney stones, neoplastic complications within the urinary tract and renal insufficiency. Proper diagostics of urinary tract function and morphology enables choosing of an adequate bladder emptying strategy, early recognition and effective treatment of urinary comlications in spinal injury with neurological deficit patients.
Study purpose: Presentation of contemporary methods of functional, imaging and endoscopic diagnostic tests of the lower urinary tract in patients with spinal injury with neurological deficit. We discuss clinical value and accuracy of particular diagnostic methods in prevention and monitoring of the therapy of urinary complications.
Study form: Literature review.
Conclusions: Although urodynamic studies serve as the principal tool among the modern methods of the lower urinary tract function assessment, simple functional tests such as residual volume measurement or cystometrogram may be helpful in clinical practice, particulary during the early posttraumatic phase. Ultrasonographic examination is the first choice imaging study. Clinical validity of screening cystoscopy in spinal injury with neurological deficit patients remains doubtful, but this procedure is of unquestionable value in cases with haematuria.