Objective:
Neurogenic bladder is a common complication in patients with spinal cord injury. Proper management of neurogenic bladder is important to prevent secondary complications including urinary tract infection, vesicoureteral reflux and renal deterioration. Because of psychological factors, many patients choose reflex voiding or voiding with Crede or Valsalva maneuver, despite being recommended intermittent catheterization(IC) by many physicians. These methods result in increased intravesical pressure and urinary retention in patients with spinal cord injury. Previous studies of benign prostate hyperplasia revealed chronic bladder obstruction associated to bladder wall thickening and loss of elasticity. This study aims to evaluate association between trabeculated bladder and voiding methods, to find optimal voiding method in preventing bladder wall deterioration in patients with spinal cord injury.
Method:
This retrospective study included fifty four patients with spinal cord injury with documented symptom of neurogenic bladder. Voiding cystourethrogram(VCUG) was conducted between 2010 and 2016. Trabeculated bladder were diagnosed based on VCUG. Patients were divided into four groups according to voiding methods; IC, indwelling catheterization, self voiding methods combined with IC, and self voiding methods only. Self voiding methods included reflex voiding and voiding with Crede or Valsalva maneuver. The Pearson’s chi-square test and Fisher exact test were used for comparing categorical data and Kruskallwallis test for continuous values. Statistical significance was defined as P<0.05.
Result
Baseline characteristics including ages, duration of illness, cause, neurologic level of injury, severity and medication history are shown in table 1. Significant differences among groups were not shown. The rate of trabeculated bladder was only significantly higher in self voiding method group compared to IC group [85.7% vs 34.6%,p=0.03].
Conclusions
This cross sectional study suggests trabeculated bladder was more frequent in patients using self voiding methods compared with patients using IC. Self voiding methods needs more concern as it not only affects the upper urinary tract, but also the bladder function. Future studies should include more subject numbers and analysis of bladder function to elucidate the benefits of IC according to the extent of disease.
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