1/5. Long-term follow-up of percutaneous radiofrequency sacral rhizotomy.A series of 7 patients undergoing percutaneous radiofrequency sacral rhizotomy to change a hyperreflexic to an areflexic bladder was reported in 1978. A patient from this original series was seen for treatment nine years later with successful preservation of good vesical capacity enabling him to use Crede maneuver and intermittent catheterization to evacuate his urine. In addition, there has been no recurrence of symptoms of autonomic dysreflexia during that period.- - - - - - - - - - ranking = 1keywords = catheterization (Clic here for more details about this article) |
2/5. Coronary reperfusion and Bezold-Jarisch reflex (bradycardia and hypotension).This study reports the occurrence of bradycardia and hypotension (Bezold-Jarisch reflex) induced by myocardial reperfusion. Among 92 patients undergoing interventional catheterization for intracoronary thrombolysis in an early phase of acute myocardial infarction, left anterior descending, right coronary, and left circumflex (LC) arteries were identified as the "infarct vessel" in 44, 41, and 7 cases, respectively. The Bezold-Jarisch reflex occurred in 15 of 23 patients (65%) after right coronary recanalization and in 1 of 34 patients after left anterior descending recanalization. The reflex also was observed in 4 (22%) of 18 patients with nonoccluded or nonrecanalized right coronary arteries. The average time from onset of symptoms to right recanalization was significantly shorter (p less than 0.01) among patients in whom the reflex did not develop. atropine, postural changes, or temporary pacing, or all 3, were generally sufficient to control symptoms. The findings of this study are substantially parallel to those reported by others and confirm that reperfusion of the inferoposterior myocardium is capable of stimulating a cardioinhibitory reflex. Follow-up data available in 15 patients with occluded and recanalized right coronary arteries indicate that the occurrence of the Bezold-Jarisch reflex after reperfusion is not a reliable predictor of myocardial salvage.- - - - - - - - - - ranking = 1keywords = catheterization (Clic here for more details about this article) |
3/5. Detrusor-sphincter dyssynergia and detrusor hyperreflexia leading to hydronephrosis during intermittent catheterization.Two cases of spinal cord injury with detrusor-sphincter dyssynergia and detrusor hyperreflexia are presented. In 1 patient bilateral hydronephrosis developed between 3 and 7 months after injury while he was on intermittent catheterization. In the other patient early sphincterotomy (3 1/2 months post-injury) was not followed by upper tract changes. Urodynamic evaluation should be done before intermittent catheterization is continued for more than 3 months after spinal cord injury. The importance of early diagnosis and appropriate management of detrusor-sphincter dyssynergia associated with detrusor hyperreflexia is discussed.- - - - - - - - - - ranking = 6keywords = catheterization (Clic here for more details about this article) |
4/5. Urinary dysfunction in lyme disease.lyme disease, which is caused by the spirochete borrelia burgdorferi, is associated with a variety of neurological sequelae. We describe 7 patients with neuro-borreliosis who also had lower urinary tract dysfunction. Urodynamic evaluation revealed detrusor hyperreflexia in 5 patients and detrusor areflexia in 2. Detrusor external sphincter dyssynergia was not noted on electromyography in any patient. We observed that the urinary tract may be involved in 2 respects in the course of lyme disease: 1) voiding dysfunction may be part of neuro-borreliosis and 2) the spirochete may directly invade the urinary tract. In 1 patient bladder infection by the Lyme spirochete was documented on biopsy. Neurological and urological symptoms in all patients were slow to resolve and convalescence was protracted. Relapses of active lyme disease and residual neurological deficits were common. Urologists practicing in areas endemic for lyme disease need to be aware of B. burgdorferi infection in the differential diagnosis of neurogenic bladder dysfunction. Conservative bladder management including clean intermittent catheterization guided by urodynamic evaluation is recommended.- - - - - - - - - - ranking = 1keywords = catheterization (Clic here for more details about this article) |
5/5. Continent reconstruction of detrusor hyperreflexia by sacral bladder denervation combined with continent vesicostomy.We describe a two-stage surgical procedure for complex hyperreflexic detrusor dysfunction refractory to conservative therapy. First, ventral and dorsal sacral rhizotomies (S2 to S4/5) are performed to restore vesical storage function and abolish autonomic dysreflexia. Then, after an interval of several weeks to allow for detrusor relaxation, continent vesicostomy is performed for suprapubic clean intermittent catheterization. The procedure is effective both objectively and subjectively, is only moderately invasive, and requires neither sophisticated nor expensive medical equipment.- - - - - - - - - - ranking = 1keywords = catheterization (Clic here for more details about this article) |