Long-term Surveillance

Case: Yearly surveillance in a 60 year old male on CIC

A 65-year-old gentleman had been suffered from a previous SCI and closed head injury related to a motor vehicle crash for 9 years. The patient had been catheterized every 3 hours using a 14 Fr straight catheter which passes easily. He has no urinary incontinence in between times of catheterization. His current medication includes oxybutynin 5 mg twice daily and 10 mg at bedtime and imipramine 10 mg 3 times daily. He came to visit urology clinic to have yearly checkup. Cystoscopy and renal ultrasound was performed.

Cystoscopy was performed in the usual manner in the lithotomy position to rule out bladder stones. We used the flexible cystoscope.  The bladder and urethra were normal except for trabeculation, there were no mucosal lesions. There are no stones. The prostate is small and normal. Renal ultrasound showed that there was no hydronephrosis.

The patient has a very stable urologic status.  People who do CIC are generally bacteriuric.  His local physician does not need to treat bacteriuria unless he is symptomatic.  We would like the patient to continue on his current regimen.  He will return to clinic in one year's time for evaluation.  He will contact the office should he have any difficulties.

Comments and Lessons: This is a typical demonstration of the patient with neurogenic bladder due to SCI on a long-term surveillance. At the time of the cystoscopy one can do a simple fiber optic cable cystometrogram (CMG). If that were done upper tract surveillance for hydronephrosis is not required provided that the CMG shows a low pressure system. Periodic screening for upper tract stone is required. At nine years most patients are quite stable and do not require the very close followup so important in the first two or three years after injury.
Patients are instructed to call us should they develop a fever, urinary leakage, autonomic dysreflexia or suffer from “urinary infections” If the latter are thought to be a problem by the patients own physician we see them and go over their situation to be certain that bladder pressures are low and there are no bladder stones or something like that which would explain the “infection”.

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