P-3-02-03
EVALUATION OF URODYNAMIC INVESTIGATION PERFORMED AFTER SPINAL CORD INJURY (SCI)
BOZ S., GENCOSMANOGLU B., YILMAZ H., HUR F., TURFAN M., CETINEL B.
(Istanbul Physical Medicine and Rehabilitation Center, Istanbul, Turkey)
Purpose: The purpose of this study was to identify and quantify the abnormalities of bladder functions in SCI patients at our center.
Method: Fifteen patients with SCI were investigated. Urodynamic evaluations and radiological investigation of urinary system (IVP) were done. All the patients were evaluated with respect to age, gender, educational level, marital status, time since injury, level and completeness of injury, tonus, autonomic dysreflexia, urinalysis and urine culture.
Results: There were 12 (80%) men, 3 (20%) women with a mean age of 29.6 years. 53.3% of them paraplegic, 46.6% were quadriplegic where 53.3% of the patients had complete lesions. Sterile intermittent catheterization were being performed to 9 (60%) of the patients. 7 (66.6%) patients had enuresis nocturna, 5 (33.3%) had urge incontinence. 73.3% of the patients had bacterial colonizations in urine cultures. The IVP results showed that 2 (13.3%) patients had upper tract, 11 (73.3%) patients had lower tract abnormalities and 9 (60%) patients had spastic bladder. Detrusor hyperrefiexia and hypocomplian bladder (40%) were the most common urodynamic diagnosis. 80% of the bladders found out to be spastic according to urodynamic evaluations.
Conclusion: Spastic bladder was the most common type of bladder in our series. Most of the patients had lower tract problems rather than upper tract. Certain basic studies are needed as baseline data after a SCI to determine the status of the urinary system and urodynamic evaluation is extremely helpful in determining the functional activity of the bladder.
P-3-02-04
INTRAVESICAL OXYBUTYNIN CHLORIDE IN PATIENTS WITH DETRUSOR HYPERREFLEXIA
Yesim Sahin, Yesim Kirazli, Ramazan Aksit, Bulent Semerci (Ege University, lzmir, Turkey)
This study was designed to investigate the efficacy of intravesical oxybutynin chloride in patients with detrusor hyperrefiexia.
Intravesical oxybutynin chloride was administered to 10 patients with detrusor hyperreflexia who were refractory to oral use or who had intolerable side effects from the medication. Ten patients, 8 men and 2 women (mean age 36.5 years, range 17-55 years) were included in the study. Detrusor hyperreflexia was due to spinal cord lesions in 8 of our patients, to myelomeningocele in 1 and to multiple sclerosis in 1. All were incontinent secondary to urodynamically proved uninhibited detrusor contractions. The patients were instructed to dissolve a 5mg tablet of oxybutynin chloride in 10cc saline and instill the solution into the bladder twice daily via a catheter. Any involuntary leakage of urine was recorded in the patient's events diary. Subjective improvement in incontinence was evaluated with visual analog scale (VAS). Cystometry was repeated after 1 month's intravesical oxybutynin therapy. Patients were followed for 6 months.
VAS and the number of incontinence improved statistically significant at 1, 3 and 6 month's of therapy (p<0.01). Maximum cystometric capacity increased from 148.6±50.3 to 263.8±81.2 ml (p<0.01). Maximum detrusor pressure decreased from 74.8±15.82 to 51.3±17.79 cmH2O (p<0.01). Vesical compliance increased from 2.22±1.32 to 6.03±3.05 ml/cmH20 (p<0.01). During follow-up (6 months) no side effects were observed.
The results suggest that intravesical instillation of oxybutynin chloride is safe and effective in the treatment of patients with detrusor hyperreflexia.
