Spinal cord injury Flashcards
principles treatment
Aims of treatment Low pressure reservoir Complete bladder emptying Prevent incontinence Quality of lie
History
bladder sensation bladder emptying how stop voiding incontinence, severity ICS urine infection quality of life bowel history sexual function
QOL questionnaires
neurological symptoms
mobility
cognition
hand function
obstetric history
shunt
surgical history
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How do you initiate a void?
Normal
Tapping
Straining, crede
Relief after voiding?
Bladder sensation
ISC
Often, get up at night, what times of date, what residuals, leakage in between (high residuals, leakage)
Flow:
How do you interrupt voiding, normal, passive, paradoxical
Incontinence
Quantity and cause, when gets urge, underwear vs outerwear, carry spare clothes, how many and what kind of pads
Rate of UTI – how many times take abx for UTI in last 12 months, how long each course
nice red flag symptoms 6
Haematuria
Recurrent UTI – three or more in last 6 months
Loin pain
Recurrent catheter blockages, i.e. within 6 weeks of being changed
Hydronephrosis or kidney stones on imaging
Biochemical evidence of renal deterioration
examination
Abdominal, ex genitalia, blood pressure
Baclofen pump, VP shunt
Spastic hyperreflexic lower limbs often go with NDO
Flaccid lower limbs often flaccid bladder
reflexes
investigations
Urine dip
US – EAU all neuropaths, NICE in those with high risk complications
PVR, flow – EAU do 2-3 times before any invasive UDS
3 day FV chart, in EAU, NICE 24 hours
VUDS
Routine cystoscopic surveillance has no place in SCI with catheters or non SCI with clam
However in those with squamous keratinizing metaplasia may consider flexi once a year
when to do VUDS
Baseline all SCI
Around 3 months after injury when spinal shock has stabilised
Repeat VUDS in those at high risk of renal complications: higher SCI, tetraplegics, SB, before surgery
VUDS when change in neurology or increase rate UTI
complete vs incomplete injury
If perineal sensation intact then incomplete injury
If complete there is no deep anal and perineal sensation or voluntary anal contraction
TBI proportion
11% of those with SCI have TBI
hand grip spinal level
If C6/7 retained can usually do ISC
C6 is required for tenodesis grip
NICE SCI lifestyle
Do recommend bladder training
Consider a behavioural management programme for example timed voiding, bladder retraining or habit retraining for those with neurogenic LUTD
Prompted voiding and habit retraining particularly suitable for people with cognitive impairment
guidelines on follow up interval
BAUS every year
EAU 6 monthly follow up?
Esp for higher level i.e. tetraplegic injuries
autonomic dysrefflexia cervical vs thoracic
• AD more common with cervical 60% than thoracic injuries 20%
