Quality of Life after Active Urological Management of Chronic Spinal Cord Injury in Eastern Taiwan

Abstract

Objective: Motor cycle accidents are the major cause of head injury and spinal cord injury (SCI) in Taiwan. The incidence of SCI in Hualien county is the highest in the world. In a community hospital in Hualien, active urological management was carried out for SCI patients with voiding dysfunctions and urological complications. This study was conducted to assess the success of active urological management. Methods: From 1988 to 1996, in the urological department, 251 SCI patients with varying voiding dysfunctions or urological complications were managed with various surgical or nonsurgical procedures according to their underlying pathologies. The satisfaction rate and quality of life index were assessed before and after active urological treatment. Results: There were 118 patients with cervical SCIs, 93 patients with thoracic or lumbar SCIs, and 40 patients with sacral SCIs or infrasacral neuropathy. After initial managements, 174 patients were able to pass urine by themselves, by clean intermittent self-catheterization (CISC) or with an indwelling Foley catheter. The remaining 77 patients suffering from severe dysuria, urinary incontinence, hydronephrosis and frequent urinary tract infections were managed with various surgical procedures. The procedures included external sphincterotomy (n = 30), enterocystoplasty (n = 28), autoaugmentation (n = 6), continent urinary diversion (n = 7), periurethral Teflon injection (n = 3), and transurethral resection of the prostate (n = 3). After treatment, hydronephrosis resolved in 100% of the kidney units; frequent symptomatic urinary tract infection improved in 83.3% after external sphincterotomy and 75% after enterocystoplasty and continent diversion; while urinary incontinence disappeared or improved in 93% after enterocystoplasty and autoaugmentation. The total satisfaction rate was 84.4% after the surgical procedures. The mean quality of life index improved from –1.27 ± 0.39 to +1.54 ± 0.38 after management. However, some complications such as mucus secretion (76.5%), abdominal pain (20.6%), loose stool (23.5%) and frequent stone formation (11.8%) still bothered the patients undergoing enterocystoplasty and continent diversion. Repeat sphincterotomy was necessary in 16.7% of patients, and 50% were not satisfied with total incontinence after external sphincterotomy. During the follow-up period, 87% of all patients had ≥1 yearly episode of urinary tract infection after spinal injury and 11 patients died of urosepsis. Conclusions: Active urological management to improve quality of life and to treat urological complications in SCI patients is mandatory. After long-term follow-up, SCI patients can be free of indwelling catheters, hydronephrosis usually resolves and urinary tract infections are infrequent.