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Urologic management of spinal cord injury in children
1Department of Surgery (Urology), Milton S. Hershey Medical Center, Pennsylvania State University, Hershey.
Insights
This study presents a bladder management program for children with spinal cord injury, emphasizing low-pressure storage and clean intermittent catheterization for improved social acceptance and self-image.
Area of Science:
- Pediatric Urology
- Spinal Cord Injury Management
- Bladder Dynamics
Background:
- Children with spinal cord injury often face challenges in bladder management.
- Traditional methods can lead to complications like high voiding pressures and impracticality of collection devices.
Purpose of the Study:
- To outline a comprehensive bladder management program for pediatric spinal cord injury patients.
- To focus on achieving low-pressure urine storage and predictable bladder emptying.
Main Methods:
- Pharmacological and surgical modulation of the bladder to create a low-pressure reservoir.
- Implementation of clean intermittent catheterization (CIC) for bladder emptying.
- Parental involvement in CIC when children are unable to self-catheterize.
Main Results:
- Avoidance of deleterious effects associated with high voiding pressures.
- Elimination of the need for impractical urinary collection devices in prepubertal boys.
- Establishment of predictable bladder emptying for enhanced social acceptability.
Conclusions:
- The described bladder management program improves children's self-image.
- This approach increases the likelihood of useful societal participation and a fulfilling life for affected children.
Abstract:
This overview of the management of children with spinal cord injury has focused on a program based on bladder dynamics. The bladder is modulated pharmacologically and surgically, if necessary, to create a reservoir that stores urine at low pressure, and emptying is achieved by clean intermittent catheterization. The parent assumes the responsibility for bladder emptying when the child is unable to perform catheterization. Reflex voiding in a balanced fashion is not advocated. The program described not only avoids the deleterious effects of high voiding pressures, it also obviates the wearing of a urinary collection device, which is impractical for most prepubertal boys, and it provides for emptying at predictable intervals in order to make the child more socially acceptable. This approach seems to improve the child's self-image, and it should increase the chances of useful participation in society and a fulfilling life.