Qui traiter, quand traiter, comment traiter chez les patients ayant une vessie neurologique ?

Abstract

Urinary tract infection is a very common complication in neurogenic bladder disorders. Risk factors include large post-voiding residues, high pressure voiding, vesico-ureteral reflux, lack of perineal hygiene. Indwelling catheterization and external collectors are associated with a high infection rate. If spontaneous voiding is inadequate, intermittent self catherization is usually the best method to apply. Clean intermittent self catheterization does not present a significantly greater risk of infection than intermittent self sterile catheterization. There is a wide range of material and techniques for intermittent catheterization. Treatment is not necessary for asymptomatic bacteriuria in most patients. Symptomatic infection should be treated with antibiotics for 7 to 14 days. Nevertheless data is lacking and more systematic studies should be made to define the best way to prevent and treat UTIs in patients with neurologic diseases, and to identify better markers of tissue infection. It is mandatory to implement long term follow-up for these patients to avoid urological complications and to check for efficient voiding.