Current Surgical Treatment for Neurogenic Lower Urinary Tract Dysfunction in Patients with Chronic Spinal Cord Injury

J. Clin. Med, 2023 · DOI: 10.3390/jcm12041400 · Published: February 10, 2023

Simple Explanation

This study reviews surgical options for managing neurogenic lower urinary tract dysfunction (NLUTD) in patients with chronic spinal cord injury (SCI). Surgery is considered when other treatments fail to manage symptoms and complications. Surgical procedures are categorized based on their purpose: reducing bladder pressure, reducing urethral resistance, increasing urethral resistance, and urinary diversion. The choice of surgery depends on the type of LUTD identified through urodynamic tests. Factors like cognitive function, hand movement, other illnesses, how well the surgery works, and potential problems are all taken into account when deciding on the best surgical approach.

Study Duration

Not specified

Participants

Patients with chronic spinal cord injury (SCI)

Evidence Level

Not specified

Key Findings

1
The review highlights various surgical procedures like augmentation cystoplasty, bladder auto-augmentation, and sacral neuromodulation for reducing bladder pressures.
2
For reducing urethral resistance, options include external sphincterotomy, urethral stents, transurethral incision of the bladder neck, and transurethral resection of the prostate.
3
Increasing urethral resistance can be achieved through artificial urinary sphincters, sling surgeries (autologous or synthetic), adjustable continence therapy, and bulking agents.

Research Summary

This study presents a comprehensive literature review of urologic surgery for neurogenic lower urinary tract dysfunction (NLUTD) in patients with chronic spinal cord injury (SCI). Surgical procedures should be viewed as a final option for managing patients with SCI who have persistent symptoms and complications that cannot be resolved by other means. The choice of surgery depends on the type of LUTD based on urodynamic tests, cognitive function, hand motility, comorbidities, efficacy of surgery, and related complications.

Practical Implications

Personalized Surgical Approach

Tailoring the surgical intervention based on urodynamic findings and individual patient characteristics is crucial for optimal outcomes.

Comprehensive Pre-operative Assessment

Evaluating cognitive function, hand motility, and comorbidities ensures appropriate patient selection and reduces the risk of complications.

Last Resort Strategy

Surgery should be considered after conservative treatments have failed, emphasizing the importance of a comprehensive management program.

Study Limitations

1
The review is limited to the published literature and may not capture all relevant surgical techniques or outcomes.
2
The effectiveness of different surgical procedures can vary based on the skill of the surgeon and the specific characteristics of the patient.
3
Long-term complications and outcomes of certain surgical interventions may not be fully documented in the existing literature.

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