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Neurosurgery: Functional neurosurgery
Published in Hemanshu Prabhakar, Charu Mahajan, Indu Kapoor, Essentials of Geriatric Neuroanesthesia, 2019
Suparna Bharadwaj, Christine Dy-Valdez, Jason Chui
Adequate pain control, attention to temperature control, and avoidance of excessive fluid administration (bladder distension) are also important to ensure patient comfort. During macrostimulation testing, limb positions are dynamic. One must balance between securing lines and monitors while minimizing restraints of attached cables, as well as thermoregulation with exposed extremities. Patients should be encouraged to void before surgery. In our institution, we routinely use a sheath/condom catheter for patient comfort. Good patient communication, repeated reassurance, and verbal encouragement during the procedure is important in maintaining motivation.
Conservative treatment
Published in Jacques Corcos, David Ginsberg, Gilles Karsenty, Textbook of the Neurogenic Bladder, 2015
Their use aims at collecting leaking urine into a device, thus preventing urinary spilling and giving better hygienic control, better control of unpleasant odor, and a better quality of life. A condom catheter is indicated in all male patients with urinary incontinence provided that there is no skin/penile lesion and intravesical pressures during storage and voiding phase are urodynamically proved to be safe. No absolute contraindications for such appliances seem to exist.
Urinary Tract Infection
Published in Thomas T. Yoshikawa, Shobita Rajagopalan, Antibiotic Therapy for Geriatric Patients, 2005
The microbiologic diagnosis of urinary infection is based on the quantitative count of organisms isolated from the urine specimen. Specimens must be collected in a manner to minimize contamination by periurethral or, in women, vaginal secretions, and be forwarded expeditiously to the laboratory for processing. A clean-catch specimen obtained with voiding is adequate for most women. A voided specimen is not feasible for some women, especially with significant functional impairment. In-and-out catheterization should be performed to collect a specimen from these women when there is a clinical indication. Urine specimens obtained from bedpans or diapers are subject to considerable contamination, and are not appropriate. For men, a clean-catch midstream specimen can usually be obtained. When voiding is managed using a condom catheter, a clean catheter and leg bag should be applied and the urine specimen collected immediately after voiding. For subjects with indwelling urethral catheters, the urine specimen should be obtained by aspiration through the sampling port or tubing, and not from the drainage bag.
Anxiety masquerading as autonomic dysreflexia
Published in The Journal of Spinal Cord Medicine, 2019
Ryan Solinsky, Todd A. Linsenmeyer
A 57-year-old man with a past medical history of T12 AIS A SCI since 1982 presented for urodynamics. The patient had an overactive, neurogenic bladder and used intra-abdominal pressure and reflex voiding to void into an external condom catheter. He had no reported history of AD or altered autonomic control above his neurological level of injury. His relevant home medications included only 0.4 mg of tamsulosin nightly. On presentation, his supine BP was 140/80 mmHg and he appeared anxious about testing. He reported his baseline SBP at home was approximately 130 mmHg, though he noted that his BP was “always increased when I come here” [Urology clinic]. The patient had his bladder filled and SBP was noted to be elevated to 170 mmHg. Bladder filling was stopped, with urodynamics demonstrating no sensation, normal bladder wall compliance, and no bladder contractions. Given his relatively caudal neurological level of injury and the absence of history of rostral altered autonomic function, the suspicion for AD causing this acute hypertension was very low. He was told that testing was complete and he demonstrated notable relief. Approximately one minute later as we were preparing to drain his bladder, a repeat BP measurement revealed that his SBP had decreased to 150 mmHg. His bladder was then drained and his BP was noted to further decrease to 142/90 mmHg.
At-home genital nerve stimulation for individuals with SCI and neurogenic detrusor overactivity: A pilot feasibility study
Published in The Journal of Spinal Cord Medicine, 2019
Dennis J. Bourbeau, Kenneth J. Gustafson, Steven W. Brose
GNS helped subjects meet their goals for bladder management. All subjects had some urgency sensation, which they would use as a feedback signal to know when to turn the stimulator on. Urgency itself was not a concern for these subjects, but it was an indicator that the bladder was contracting and that they might leak. Subjects 2 and 5 reported that they could not always tell when they were about to have an incontinence episode, and thus used a condom catheter and leg bag. Subjects 1, 2, 3, and 4 wanted enough time to get to the bathroom upon urgency sensation without leaking. In these subjects, GNS successfully delayed the need to void sufficiently to get to a bathroom without leaking. Subject 5 wanted to keep the skin around the pelvis dry due to concern about skin damage from urine leakage. Subject 5 reported that the leakage episodes were significantly diminished and the skin stayed dry. Subjects 2 and 5 wanted to stop using a condom catheter and leg bag. GNS inhibited their bladder activity, but additional interventions are required to meet this goal, particularly a reliable feedback mechanism. These subjects reported that they did not stop using the condom catheter because they were not confident in their ability to know when they had to get to a bathroom, sometimes voiding without feeling bladder fullness or urgency.
Long-term compliance with bladder management in patients with spinal cord injury: A Saudi-Arabian perspective
Published in The Journal of Spinal Cord Medicine, 2020
Anas Jehad AlSaleh, Ahmad Zaheer Qureshi, Zilal Syamsuddin Abdin, Ahmed Mushabbab AlHabter
There is very limited literature on bladder management on SCI in KSA or in the neighboring countries. Two quality of life surveys were carried out at follow up visits for individuals with SCI who were rehabilitated between 1982 and 2003 in Riyadh region which included 57 males and 50 females.12,13 Most of the male patients were using condom catheter whereas nearly one-fourth of the patients were on CIC at the time of survey.12 The female survey showed that 64% were using CIC and 22% used IFC.13 These surveys did not analyze the bladder management at the time of discharge; which was carried out in our study. There are no similar studies in the neighboring countries of Arabian Peninsula.