Return Of Bladder Function Research Articles

What Do Nurses Prefer? A Cross-sectional Study of Catheter Preference After Pelvic Organ Prolapse Surgery.

The purpose of this study was to determine nursing preferences regarding catheter type (transurethral indwelling catheters vs intermittent catheterization vs suprapubic tube drainage) when caring for patients in hospital after pelvic organ prolapse surgery. Cross-sectional survey study. Registered nurses practicing in academic and community hospitals across North America (the United States and Canada). Three hundred fifty-four RNs who routinely care for patients after pelvic organ prolapse surgery from centers across North America were sent an electronic survey between February 2018 and March 2019. The survey comprised 24 questions that collected information on the participants' demographics and their experience with using different catheters in a hospital setting, along with knowledge of and preference for the different catheter types. Descriptive statistics were used to determine catheter preferences of respondents in addition to their catheter rankings according to catheter-related outcomes. One hundred sixty nurses completed the survey, representing a 45% response rate. More than half (63.1%, n = 101) of respondents stated a preference for transurethral indwelling catheters, 23.1% (n = 37) preferred suprapubic tubes, and 10.6% (n = 17) preferred intermittent catheterization. Transurethral indwelling catheters were ranked by nurses as the best catheter type for ease of use and pain/discomfort for patients. Intermittent catheterization was ranked by nurses as the best for lowest malfunction rates and return of bladder function. Suprapubic tubes were ranked by nurses as best for lowest infection rates. This study has demonstrated that nurses practicing in inpatient care units have a strong preference for transurethral indwelling catheters over intermittent catheterization and suprapubic tubes when caring for patients after pelvic organ prolapse surgery.

Ambulatory Surgery Patients May Be Discharged before Voiding after Short-acting Spinal and Epidural Anesthesia

Voiding before discharge is usually required after outpatient epidural or spinal anesthesia because of concern about bladder overdistention and dysfunction. Shorter duration spinal and epidural anesthesia may allow return of bladder function before overdistention occurs in low-risk patients (those younger than age 70, not having hernia, rectal, or urologic surgery, and without a history of voiding difficulty), and predischarge voiding may not be necessary. After institutional review board approval and informed consent, 201 low-risk ambulatory patients were prospectively studied in either a standard or accelerated pathway after undergoing spinal or epidural anesthesia with procaine, lidocaine, 2-chloroprocaine, or less than 7 mg bupivacaine; epinephrine was not used in any anesthetic. Standard pathway patients (n = 70) were required to void before discharge. Accelerated pathway (n = 131) patients were not required to void. (After randomization of an initial 163 patients to one of the two tracks, 38 additional patients were assigned to the accelerated pathway.) If accelerated pathway patients voided, they were discharged when all other discharge criteria were met. If they did not spontaneously void after block resolution, a bladder ultrasound (BUS) was performed. If the BUS indicated a urine volume of less than 400 ml, the patients were discharged and instructed to return to the emergency department if they were unable to void within 8 h of discharge. If the BUS indicated a urine volume of greater than 400 ml, the patients were reassessed in 1 h and were discharged if they could void spontaneously. If they could not void spontaneously, they were catheterized to facilitate discharge. All patients were contacted the next day to assess the return of normal bladder function. All standard pathway patients voided without difficulty, and were discharged in 153 +/- 49 (SD) min. 62 patients in the accelerated pathway voided spontaneously after resolution of their block and were discharged in 127 +/- 41 min. 46 patients were discharged with a BUS less than 400 ml in 120 +/- 42 min. 23 patients had a BUS greater than 400 ml: of these, 20 patients voided within an hour and were discharged in 162 +/- 45 min. Three were catheterized after 1 h, and were discharged in 186 +/- 61 min. Mean discharge time for all patients in the accelerated pathway was 22 min shorter than the standard pathway (P = 0.002). No patients had difficulty voiding or returned to the hospital for urinary problems. None reported new urologic symptoms. Delay of discharge after outpatient spinal or epidural anesthesia with short-duration drugs for low-risk procedures is not necessary, and may result in prolonged discharge times.

Systemic Lupus Erythematosus: A Unique Cause of Central Cord Syndrome, a Case Report

Central cord syndrome has classically been defined by disproportionately more motor impairment of the upper than the lower extremities, bladder dysfunction, and varying degrees of sensory loss below the level of the lesion. Review of the literature indicates that the majority of causes of central cord syndrome have a traumatic etiology and few are a consequence of connective tissue disorders. This is a case of a 53-year-old female with systemic lupus erythematosus who developed central cord syndrome due to an exacerbation of her disease. The patient presented with upper extremity motor and sensory deficits but only sensory deficits of the lower extremities. She had laboratory abnormalities consistent with lupus, and magnetic resonance imaging of the cervical spine revealed decreased attenuation from C-1-T-2. High-dose intravenous steroids were started in the acute care hospital with some return of proximal upper extremity strength. Upon transfer to the acute rehabilitation unit, the patient was noted to have neurogenic bladder dysfunction requiring a catheterization program. The patient was slowly tapered down on her oral prednisone with minimal improvement of strength but with return of bladder function. A review of the literature revealed few cases of central cord syndrome secondary to a connective tissue disorder or a non-traumatic etiology.

Combined medical and surgical treatment after acute spinal cord injury: results of a prospective pilot study to assess the merits of aggressive medical resuscitation and blood pressure management

The optimal management of acute spinal cord injuries remains to be defined. The authors prospectively applied resuscitation principles of volume expansion and blood pressure maintenance to 77 patients who presented with acute neurological deficits as a result of spinal cord injuries occurring from C-1 through T-12 in an effort to maintain spinal cord blood flow and prevent secondary injury. According to the Intensive Care Unit protocol, all patients were managed by Swan-Ganz and arterial blood pressure catheters and were treated with immobilization and fracture reduction as indicated. Intravenous fluids, colloid, and vasopressors were administered as necessary to maintain mean arterial blood pressure above 85 mm Hg. Surgery was performed for decompression and stabilization, and fusion in selected cases. Sixty-four patients have been followed at least 12 months postinjury by means of detailed neurological assessments and functional ability evaluations. Sixty percent of patients with complete cervical spinal cord injuries improved at least one Frankel or American Spinal Injury Association (ASIA) grade at the last follow-up review. Thirty percent regained the ability to walk and 20% had return of bladder function 1 year postinjury. Thirty-three percent of the patients with complete thoracic spinal cord injuries improved at least one Frankel or ASIA grade. Approximately 10% of the patients regained the ability to walk and had return of bladder function. As of the 12-month follow-up review, 92% of patients demonstrated clinical improvement after sustaining incomplete cervical spinal cord injuries compared to their initial neurological status. Ninety-two percent regained the ability to walk and 88% regained bladder function. Eighty-eight percent of patients with incomplete thoracic spinal cord injuries demonstrated significant improvements in neurological function 1 year postinjury. Eighty-eight percent were able to walk and 63% had return of bladder function. The authors conclude that the enhanced neurological outcome that was observed in patients after spinal cord injury in this study was in addition to, and/or distinct from, any potential benefit provided by surgery. Early and aggressive medical management (volume resuscitation and blood pressure augmentation) of patients with acute spinal cord injuries optimizes the potential for neurological recovery after sustaining trauma.

Spinal Cord Injury and Bladder Recovery

Abstract Objective: To investigate whether spinothalamic tract preservation and posterior column sparing are predictors of neurogenic recovery of bladder function after spinal cord injury (SCI). Designs and Participants: In a retrospective review, the initial perianal pinprick sensation (S 4,5 dermatomes) and position sense of the great toes were examined and correlated with bladder function at 1 year after SCI in 19 consecutive spinal cord injured patients (age 18 to 68 years), Frankel A-D, with spinal injury (level C-4-T-12). All patients were admitted to the Regional Spinal Cord Injury Center of Delaware Valley (RSCIDDV) within 72 hours of injury between July 1990 and June 1991 and were available for a 1-year follow-up evaluation. Main Outcome Measures: The correlation of initial perianal pinprick and great toe position sensation with bladder management approximately 1 year after SCI. Results: During the initial 72 hours, 10 of the 19 patients had positive perianal pinprick sensation and 9 did not feel the pin. Eight patients had positive great toe position sense, and 11 had no proprioception. At the 1-year follow-up visit, 7 of the 10 patients with initial preserved perianal pinprick were voiding volitionally, whereas none of the 9 patients who did not have pinprick voided volitionally at 1-year after SCI. Six of the 8 with initial preserved great toe position sense were voiding volitionally at 1 year, but only 1 of the original 11 without initial toe position sense was voiding volitionally. Conclusions: Both perianal pinprick sensation and toe position sense are sensitive in predicting return of bladder function. Although both tests have positive predictive value, their negative predictive values are much more noteworthy. A patient without initial position sense of the great toes will likely not regain volitional voiding, whereas a patient without initial perianal pinprick sensation will definitely not regain volitional voiding.

Combined medical and surgical treatment after acute spinal cord injury: results of a prospective pilot study to assess the merits of aggressive medical resuscitation and blood pressure management.

The optimal management of acute spinal cord injuries remains to be defined. The authors prospectively applied resuscitation principles of volume expansion and blood pressure maintenance to 77 patients who presented with acute neurological deficits as a result of spinal cord injuries occurring from C-1 through T-12 in an effort to maintain spinal cord blood flow and prevent secondary injury. According to the Intensive Care Unit protocol, all patients were managed by using Swan-Ganz and arterial blood pressure catheters and were treated with immobilization and fracture reduction as indicated. Intravenous fluids, colloid, and vasopressors were administered as necessary to maintain mean arterial blood pressure above 85 mm Hg. Surgery was performed for decompression and stabilization, and fusion in selected cases. Sixty-four patients have been followed at least 12 months postinjury by means of detailed neurological assessments and functional ability evaluations. Sixty percent of patients with complete cervical spinal cord injuries improved at least one Frankel or American Spinal Injury Association (ASIA) grade at the last follow-up review. Thirty percent regained the ability to walk and 20% had return of bladder function 1 year postinjury. Thirty-three percent of the patients with complete thoracic spinal cord injuries improved at least one Frankel or ASIA grade. Approximately 10% of the patients regained the ability to walk and had return of bladder function. As of the 12-month follow-up review, 92% of patients demonstrated clinical improvement after sustaining incomplete cervical spinal cord injuries compared to their initial neurological status. Ninety-two percent regained the ability to walk and 88% regained bladder function. Eighty-eight percent of patients with incomplete thoracic spinal cord injuries demonstrated significant improvements in neurological function 1 year postinjury. Eighty-eight percent were able to walk and 63% had return of bladder function. The authors conclude that the enhanced neurological outcome that was observed in patients after spinal cord injury in this study was in addition to, and/or distinct from, any potential benefit provided by surgery. Early and aggressive medical management (volume resuscitation and blood pressure augmentation) of patients with acute spinal cord injuries optimizes the potential for neurological recovery after sustaining trauma.

Intense peripheral electrical stimulation evokes brief and persistent inhibition of the nociceptive tail withdrawal reflex in the rat

In a study of modulation of nociception by sensory inputs, electrical stimulation was applied to specific sites in the hindlimb and effects on the nociceptive tail withdrawal reflex were monitored in the lightly anaesthetized rat. Stimulation was applied to previously defined sites in the hindlimb, meridian points femur-futu (ST-32), fengshi (GB-31) and zusanli (ST-36). It consisted of a 4 Hz train of 2 ms square pulses given for 20 min at 20 × the threshold intensity required for muscle twitch. Tail withdrawal was provoked by application of a noxious heat stimulus applied to the tip of the tail. Results were expressed as a percentage of the maximal possible inhibition which is achieved when the post-treatment latency is 2 × the pre-treatment latency otherwise known as the cut off. During stimulation, the latency of the withdrawal increased to ≈ 70% of the maximal possible inhibition. Following stimulation, the inhibition persisted for > 1 h. Stimulation at 2 or 6 Hz elicited similar effects but stimulation at 8 Hz evoked inhibition during the stimulation only. Stimulation applied to sites away from defined meridian points inhibited tail withdrawal during the stimulation; no post-stimulation effect was produced. In acutely transected animals (≤ 48 h), stimulation of meridian points elicited a small, brief increase in latency but during stimulation only. At 7 and 14 days after spinal transection, this response during stimulation was greater in magnitude and a brief post-stimulation increase was also observed. The return of the of this latter effect was coincident with the return of bladder function. These data suggest that high intensity, low frequency electrical stimulation of hindlimb meridian points in the lightly anaesthetized rat produces both brief and persistent inhibitory effects on the nociceptive tail withdrawal reflex. These effects appear to be elicited by different mechanisms. The persistent effect may represent a plastic change in central inhibitory mechanisms. Data from spinal animals indicate a major participation of supraspinal structures but that spinal mechanisms are also capable of sustaining both types of effect.

Return of Bladder Function: A Research Study

Return of Bladder Function: A Research Study

The effect of human chorionic gonadotropin (HCG) on functional recovery of spinal cord sectioned rats.

The effect of human chorionic gonadotropin (HCG) on functional recovery after complete spinal cord transection in the rat was studied. Twelve rats (6 male and 6 female) received HCG daily for the first week and then every alternate day for three weeks. Ten rats (5 male and 5 female) served as controls. Return of bladder function, Tarlov's grading and measuring the maximum angle at which the rats were able to climb up an inclined plane were used as criteria in assessing the functional recovery. Improvement was noted in the HCG-treated rats by the end of two weeks. At six weeks the recovery of HCG-treated rats as compared to the control group was very significant (p less than 0.001). No recovery whatsoever was noted in the control group even after six weeks. Histological evidence of bridging of the gap between the cut ends of the spinal cord by nerve fibres containing tissue was noted in the HCG-treated rats only. The possible mode of action of HCG on spinal cord injury is briefly discussed.

New concept of vesical innervation; relationship of vesical innervation to bladder management following abdominoperineal proctosigmoidectomy.

VESICAL dysfunction following some types of lower abdominal or pelvic surgery is known to occur occasionally. It is believed that this dysfunction is of neurogenic origin. In 1946 a theory of the causative factors of vesical dysfunction following abdominoperineal proctosigmoidectomy was presented.1At that time it was stated that such dysfunction was believed to be of neurogenic origin and resulted from excision of the inferior hypogastric and pelvic plexuses; that the bladder responded as if a sympathetic nerve predominance existed; and that the return of bladder function was due to nerve regeneration. Many of these statements have been proved to be incorrect. It is still believed that vesical dysfunction following abdominoperineal proctosigmoidectomy is of neurogenic origin. However, in the interim since the previous report, basic research on the innervation of the bladder has been done. Through the medium of this research, it has been demonstrated that nerve fibers accessory