脊髄損傷後の膀胱管理について理解する

When someone injures their spinal cord, it can mess up how their bladder works. This might happen because of an accident, a disease, or if the spinal cord doesn’t get enough blood. This injury can cause bladder infections or problems with kidneys and peeing. After such an injury, it’s really important to take care of the bladder. The care needed can change depending on who you are, your daily habits, if your hands work well, and if you can see a doctor easily. Good care means fewer problems and a better life.

A lot of people with spinal cord injuries find it hard to control their bladder. Everyone is different, so they need their own plan for care, and they might have to go to the doctor a lot. Many end up in the hospital or a nursing home because of bladder issues.

Normally, our brain tells our bladder when to hold pee and when to let it go. If the spinal cord is hurt, it can’t send these messages right. Right after a big injury, the body can be in shock, and the bladder doesn’t work. The person can’t feel when it’s time to pee and might need a tube, called a catheter, to help them.

If the injury is high up on the spine, the bladder might start working again but without control. So, you might feel when it’s full but can’t stop the pee. This can be bad for the kidneys if it’s not taken care of.

If the injury is lower down, near the hips, the bladder and muscles might get too loose. If it’s a complete injury, the person can’t feel when the bladder is full and can’t pee by themselves. This can mean a bladder that doesn’t squeeze and muscles that don’t relax as they should, maybe because the nerves are damaged.

神経因性膀胱の合併症

People with spinal cord injuries  often have bladder problems called neurogenic bladder. The most common issues are urinary tract infections, bladder stones, and kidney damage. These problems are related to the bladder not working right or from using tubes, called catheters, to drain urine.

People with SCI get urinary infections often. Studies show that using coated catheters can lower the risk of infections compared to regular PVC catheters. Taking antibiotics all the time to prevent infections doesn’t work well for SCI patients and can lead to the antibiotics not working anymore. Other treatment plans might help reduce this problem.

Some treatments to lower infection risk include using a medicine called me-henamine or cranberry pills every day. But for people with SCI who have stable bladder care, these don’t seem to stop infections. An interesting way to prevent infections is to put a harmless type of E. coli bacteria into the bladder.

Problems like urethritis and prostatitis can be lessened by using catheters only sometimes. Testicle and epididymis infections are often linked to catheters and are treated with antibiotics. Bladder and kidney stones happen because of infections, long-term catheters, and not emptying the bladder fully. The risk of bladder cancer is 20 times higher in people with SCI, and the most common type is squamous cell cancer.

A condition called autonomic dysreflexia causes high blood pressure, slow heart rate, and sweating. It happens in people with SCI above the T6 level and is a medical emergency.

脊髄損傷のその他の重篤な合併症

Spinal cord injury can cause urinary retention and severe hydronephrosis.

• Urinary retention, the inability to fully empty the bladder during urination, can occur due to disrupted nerve signals in SCI. This leads to urine build-up in the bladder, causing discomfort and raising the risk of urinary tract infections.

• Severe hydronephrosis is the kidneys’ excessive swelling from blocked urine flow in the drainage system. In SCI cases, nerve damage affects normal urinary system function, hindering kidney drainage and causing urine accumulation, leading to hydronephrosis.

Both urinary retention and severe hydronephrosis are serious SCI complications needing medical attention to prevent further issues and maintain urinary health.

保守的な管理

The standard care for managing a neurogenic bladder includes educating the patient, following a urination schedule, using techniques like Valsalva and Credé, medication, intermittent catheterization, or leaving a drainage tube. Regular bladder emptying is crucial to prevent infections, upper urinary system damage, and leaks.

For individuals with spinal cord injuries, intermittent catheterization is preferred for urination. Leaving a catheter in place can increase the risk of infections, kidney damage, and other complications. Anticholinergic medications are commonly used to treat an overactive bladder muscle, improving bladder function and quality of life with varying side effects.

In the long run, conservative management acts as an ongoing risk-reduction strategy, with patients facing largely irreversible symptoms. Patients and healthcare providers are inclined to consider surgical interventions for better outcomes, especially for those at higher risk of complications.

伝統的な外科的治療

1. Bladder Atony Procedure: A 2cm bladder puncture below the navel to drain residual urine from the bladder by leaving a catheter in place.

2. Indwelling Catheterization: Draining residual urine from the bladder by placing a catheter through the urethra.

3. Intermittent Catheterization: Periodically inserting a catheter through the urethra to drain residual urine from the bladder.

Post-Treatment Outcomes: Traditional treatment methods focus on draining residual urine from the bladder to prevent kidney hydronephrosis and urinary tract infections. However, prolonged use of catheters or drainage tubes can lead to bladder spasms, urinary tract infections, and stones. These treatment methods can only partially improve patients’ lives, prevent further complications, prolong life, but cannot fundamentally resolve the issues of urinary dysfunction.