History of SCI Management 

  • Many different techniques for the management of lower urinary tract dysfunction have been introduced over the past 50 years and the treatment of neurogenic bladder has undergone considerable changes. These have been applied, however, only a few of these procedures have stood the test of time.
  • About 40 years ago, most SCI patients were taught to empty their bladder with tapping or the Credé maneuver
  • Introduction of external sphincterotomy
  • Lapides et al introduced the technique of CIC
  • The incidence of urologic complications, once a leading cause of patient morbidity and mortality, dramatically decreased. Other factors contributed to the reduction of long-term renal complications are as follows [Jamil 2001]:
    • Improved bladder management including the introduction of CIC technique (link to the CISC-1. Importance of the clean intermittent cath.doc)
    • Effective control of the UTI including the discovery of new antibiotics
    • Advancement in the treatment of the urinary stone
    • Education for SCI patients and caregivers
    • Establishment of the special SCI care centers
    • Introduction of long term surveillance program on the kidney
    • Introduction of modern urodynamic technique and facilities
Key Points of This Section
  • Many different techniques for the management of lower urinary tract dysfunction have been introduced over the past 50 years.
  • The incidence of urologic complications dramatically decreased as the treatment of neurogenic bladder has undergone considerable improvements.

References

  • Gallien P, Nicolas B, Robineau S, Le Bot MP, Durufle A, Brissot R. Influence of urinary management on urologic complications in a cohort of spinal cord injury patients. Arch Phys Med Rehabil. 1998 Oct;79(10):1206-9.
  • Jamil F. Towards a catheter free status in neurogenic bladder dysfunction: a review of bladder management options in spinal cord injury (SCI). Spinal Cord. 2001 Jul;39(7):355-61.
  • Lapides J, Diokno AC, Silber SJ, Lowe BS. Clean, intermittent self-catheterization in the treatment of urinary tract disease. J Urol. 1972 Mar;107(3):458-61.
  • McKinley WO, Jackson AB, Cardenas DD, DeVivo MJ. Long-term medical complications after traumatic spinal cord injury: a regional model systems analysis. Arch Phys Med Rehabil. 1999 Nov;80(11):1402-10.
  • Stover SL, Lloyd LK, Waites KB, Jackson AB. Urinary tract infection in spinal cord injury. Arch Phys Med Rehabil. 1989 Jan;70(1):47-54.
  • Timoney AG, Shaw PJ. Urological outcome in female patients with spinal cord injury: the effectiveness of intermittent catheterisation. Paraplegia. 1990 Nov;28(9):556-63.
  • Yavuzer G, Gok H, Tuncer S, Soygur T, Arikan N, Arasil T. Compliance with bladder management in spinal cord injury patients. Spinal Cord. 2000 Dec;38(12):762-5.

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