This article summarizes 32 cases of the SCI patients suffered from bladder stones.Respects relating to causes,characteristic,diagnosis,treatment and prevention of bladder stones after SCI are discussed in the article.In order to decrease or avoid complication of indwelling urethral catheter,the patients with neuropathic bladder dysfunction are treated by intermittent catheterization.If it is necessary for SCI patients to indwell urethral catheter,we must strengthen management of the catheter and renew a catheter in time(once a week).

Objective To evaluate the effects of Botulinum-A toxin (BTX-A) injection into detrusor to treat detrusor hyperreflexia and neurogenic incontinence in the patients with spinal cord injury (SCI). Methods A total of 31 patients with SCI(mean age,30 years;male 20,female 11) were included into the study.All the patients underwent urodynamic examination and voiding diary was recorded.300 U of BTX-A was dissolved in 15 ml of saline,and the solution of BTX-A was injected into 30 different points in detrusor using a flexible cystoscopic needle.The evaluation for the effects and follow-up included voiding diary,urodynamic testing and observation of adverse and toxic effects. Results After the first injection,29 of the 31 patients had symptom relief within 3 to 14 days;4 cases received the second injection;4 cases were treated in combination with anticholinergic medication;and 2 cases had no improvement and,therefore,received other treatments.The mean follow-up was 8.5 months. After 3-week treatment of BTX-A,the mean frequency of incontinence decreased from 14.2 to 2.5 times per day.The mean volume of intermittent catheterization (IC) increased from 124 to 495 ml each time.Urodynamic data showed that mean cystometric bladder storage volume increased from 133 to 475 ml,mean maximum storage detrusor pressure decreased from 62.7 to 17.1 cmH 2O(1 cmH 2O=0.098 kPa).No adverse and toxic effect was observed. Conclusions Our initial experience suggests that Botulinum-A toxin injection into detrusor to treat detrusor hyperreflexia and neurogenic incontinence in patients with SCI may be an effective,safe,feasible and micro-invasive treatment choice.However,it is necessary to observe its long term outcome.

目的探讨输尿管膀胱扩大治疗神经源性膀胱的适应症、手术技术和疗效。方法报道1例采用输尿管膀胱扩大治疗的神经源性膀胱患者。结果手术后患者膀胱容积扩大,肾积水和肾功能获得了改善,未出现并发症。结论输尿管膀胱扩大对于选择性的神经源性膀胱患者是一种理想的膀胱扩大方式。

人工尿道括约肌, 真性压力性尿失禁, 康复治疗

ObjectiveTo observe the effect of urethral stent implantation on detrusor-sphincter dyssynergia caused by neurogenic lower urinary tract dysfunction.Methods13 patients with detrusor-sphincter dyssynergia caused by neurogenic lower urinary tract dysfunction were treated with the operation of the urethral stent implantation. Voiding function, renal function, residual urine volume and hytronephrosis were examined before and after the operation to evaluate the effect of this procedure.ResultsAfter operation, 7 patients normally emptied their bladders and 6 patients had urinary incontinence. Urethral stents were removed from 2 patients in this group due to the irritation symptoms, the second implantation was performed in a patient due to the voiding difficulty. The renal function of patients after the operation had a non-significant improvement, but the residual urine volume and hytronephrosis improved significantly.Conclusion Urethral stent implantation can decrease residual urine volume and hytronephrosis in patients with detrusor-sphincter dyssynergia caused by neurogenic lower urinary tract dysfunction.

Objective To evaluate the effectiveness and safety of Botulinum toxin-A (BTX-A) injection into detrusor to treat neurogenic detrusor overactivity in patients with spinal cord injury (SCI).Methods A total of 78 patients with SCI were treated with transurethral injection of BTX-A (300 IU dissolved in 15 ml of saline) into 30 different points of detrusor with 15 ml in every patients. Urodynamic parameters and voiding diary were assessed at baseline and 3 weeks and 3 months after the injections. Adverse events were recorded after the injection if present.Results After the first injection, 78 patients showed that the mean frequencies of incontinence decreased from 13.5 to 2.7 times per day, the mean volume of intermittent catheterization (IC) increased from 131 ml to 389 ml per time, the mean volume of incontinence decreased from 1 690 ml to 281 ml per day, the mean getting effect time was 7.6 days. 10 patients received second injection at 8.9 months after first injection, the results showed that the mean frequencies of incontinence decreased from 9.7 to 3.7 times per day, the mean IC volume increased from 108 ml to 387 ml. 6 patients received third injection at 5.8 months after second injection, the results showed that the mean frequencies of incontinence decreased from 9.2 to 3.9 times per day, the mean IC volume increased from 116 ml to 364 ml. No side effects were observed during the follow-up.Conclusion BTX-A injection into detrusor to treat neurogenic detrusor overactivity in patients with SCI seems to be an effective, safe and miniinvasive solution.

ObjectiveTo search for the optimal treatment of hydronephrosis after spinal cord injury .Methods46 cases were treated by indwelling catheter, intermittent catheterization and drug therapy, and comprehensive therapy respectively. The course of treatment and the recurrence rate were observed after hydronephrosis remitted. Results There were no differences in the course of treatment among the three different kinds of therapy. The recurrence rate of the detrusor sphincter dyssynergia(85.7%) was higher than that of the detrusor hyperreflexia (35%) and the detrusor hyporeflexia(25%).ConclusionsThe optimal therapy on slight and moderate hydronephrosis should be intermittent catheterization and drug therapy to avoid the complications of long term indwelling catheter. SCI hydronephrosis is indistinct and recurrent easily. B ultrasound for kidneys is helpful in discovering SCI hydronephrosis on early stage. The earlier the treatment, the better the prognosis. Urodynamics plays an important role in the management of SCI hydronephrosis.