CLINICAL EVALUATION ON TREATMENTS IN 70CASES OF NEUROGENIC BLADDER

Abstract

Clinical evaluation on treatments of 70cases of neurogenic bladder experienced in the past 3years was carried out. The age of the patients ranged from 13 to 87years (average 58.4years) and sex distinction was 48males to 22females. Duration from the onset of urological symptoms to the first visit in our clinic was more than 6months in half of the patients.
Classification of neurogenic bladder was: 16cases of brain bladder, 25cases of spinal cord bladder, 21cases of peripheral neuropathic bladder and 8cases of other or unknown causes. As the etiology of neurogenic bladder, intrapelvic operations were most frequent and cerebro-vascular diseases and spinal cord injuries followed. Urological complications were 27cases of urinary tract infection, 12cases of benign prostatic hypertrophy, 3cases of renal dysfunction, 3cases of urethral caruncles and others. Residual urine was found in 61% of the patients. Cystometric patterns were classified as 48cases (69%) of flaccid bladder, 7cases of normal type, 6cases of uninhibited bladder, 5cases of spastic bladder, 2cases of so-called inhibited bladder and 2cases of atonic bladder.
63cases (90%) were treated with conservative therapies and 7cases (10%) with surgical ones. For conservative therapies, various drugs were administered in 69cases and 30cases who had significant residual urine were managed with intermittent catheterization. 5cases of TUR-P and 2cases of cystostomy including 1case of Lapides' cutaneous vesicostomy were performed for surgical therapies.
The mean residual volume from 26cases was reduced to 84ml after the intermittent catheterization in comparison with 205ml before the treatment and the mean residual rate to 28.9% from 56.5%. 13 (43%) out of 26cases became catheter-free under the administration of drugs and intermittent catheterization together. The proportion of sterile urine after the intermittent catheterization was 54%.
The results of the present investigation revealed that conservative therapies were effective in reducing residual urine and preserving urine sterile, however, but not in making catheter-free so that additional surgical therapy was necessary.