Early urological care of patients with spinal cord injury
Early urological care of patients with spinal cord injury
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DOI：
10.1007/s00345-018-2367-7
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发表时间：
2018-10-01
影响因子：
3.4
通讯作者：
Kessler, Thomas M.
中科院分区：
文献类型：
--
作者：
Welk, Blayne;Schneider, Marc P.;Kessler, Thomas M.
PurposeAfter脊髓损伤（SCI），泌尿外科管理的最初目标，包括保持安全储存的尿液与有效的膀胱排空，最大限度地提高泌尿系统，并尽量减少泌尿系统并发症的风险。MethodsThis审查是根据联合SIU-ICUD国际咨询建议的方法。Embase和Medline数据库用于识别与SCI患者早期泌尿外科护理相关的文献。建议是通过协商一致制定的，并使用修改后的牛津系统进行分级，该系统确定了证据等级（LOE）和建议等级（戈尔）。（LOE 3，戈尔A），并在伤后3个月内进行初步神经泌尿系统评估（LOE 3，戈尔A），包括病史、经验证的问卷、膀胱日记、体格检查、肾功能测量和尿路成像（LOE 4，戈尔B）。必须进行尿动力学检查（如果有视频尿动力学检查），以检测和说明下尿路功能障碍（LOE 1，戈尔A）。一旦患者病情稳定（LOE 3，戈尔A），必须考虑对适当患者进行自发排尿和/或间歇性导尿。抗毒蕈碱药是神经源性逼尿肌过度活动（LOE 1，戈尔A）的一线治疗，逼尿肌内肉毒毒素A注射是二线治疗。不可逆的手术干预应推迟到受伤后的第二年，由于潜在的神经恢复（LOE 4，戈尔B）。ConclusionsCarefully临床评估和相关的泌尿系统检查，包括尿动力学调查是必要的适当的咨询和治疗新的SCI患者。
PurposeAfter spinal cord injury (SCI), the initial goals of urological management include maintaining safe storage of urine with efficient bladder emptying, maximising urinary continence, and minimising the risk of urological complications.MethodsThis review was performed according to the methodology recommended by the Joint SIU-ICUD International Consultation. Embase and Medline databases were used to identify literature relevant to the early urological care of SCI patients. Recommendations were developed by consensus and graded using a modified Oxford system which identifies level of evidence (LOE) and grade of recommendation (GOR).ResultsClinicians must ensure appropriate bladder emptying immediately after SCI (LOE 3, GOR A) and perform the initial neuro-urological assessment within 3months after injury (LOE 3, GOR A), including history, validated questionnaires, bladder diary, physical examination, measurement of renal function, and urinary tract imaging (LOE 4, GOR B). Urodynamics, if available video-urodynamics, must be performed to detect and specify lower urinary tract dysfunction (LOE 1, GOR A). Spontaneous voiding and/or intermittent catheterization must be considered in appropriate patients once they are medically stable (LOE 3, GOR A). Antimuscarinics are the first-line and intradetrusor botulinum toxin A injections are the second-line treatment for neurogenic detrusor overactivity (LOE 1, GOR A). Irreversible surgical interventions should be delayed until the second year after injury due to the potential for neurological recovery (LOE 4, GOR B).ConclusionsCareful clinical assessment and pertinent urological testing including urodynamic investigation are necessary for appropriate counselling and treatment of new SCI patients.