SPINAL CORD INJURY

R.A.S HEMAT, MB;BCh, FRCSI, DUL.

Female:Male ratio is 1:4

Urological dysfunction is almost universal in the SCI population, often requiring multiple endoscopic evaluation for various reasons:

  1. - Flexible cystoscopy reduces the stimulus for the development of autonomic dysreflexia
  2. - It can be performed in a variety of positions
  3. - It permits visualisation of the urinary tract
  4. - It can immediately diagnose the aetiology of a difficult urethral catheterization.

Causes of Death

- first few months is due to respiratory failure.

- after the first year is due to renal renal failure. Infarction of the spinal cord is uncommon in comparison with cerebral stroke.

The excitatory amino acids (EAA) play a key role in the initiating injury.

Types of injury:

1- Primary injury occurs at the time of mechanical trauma.

2- Secondary injury is mediated by microvascular and subsequent biochemical forces that result by the injury.

Mechanisms of injury in SCI

1- hyperflexion

2- Hyperextension

3- Distraction

4- Axial loading or vertical compression

5- Penetrating trauma

Pain continues to be a significant management problem in people with spinal cord injuries. Pain following spinal cord injury includes:musculoskeletal, visceral, neuropathic and other types of pain.

Systemic effects of SCI

System
SCI
Pulmonary
    Respiratory muscle dysfunction (decrease VC, increase TLC, decrease ERV, increase RV)

    Hypoxia

    Pulmonary edema

    Pulmonary embolism

Cardiovascular
    Loss of sympathetics to heart (T1-T4)

    Loss of vascular tone

Fluids and electrolytes
    Respiratory acidosis

    Hypercalcaemia

    Hyperkalaemic response to succinylcholine

Associated injuries
    Head injury

    Other

Causes of urological complications:

  1. Residual of urine
  2. Sustained high intravesical pressures
  3. Immobilisation

Urological complications

  1. Incontinence
  2. U.T.I
  3. Hydronephrosis
  4. Calculus
  5. Renal amyloidosis
  6. Sexual dysfunction
  7. Autonomic dysreflexia

Spinal cord injury patients are reported to be at increased risk of bladder tumours, which have caused 0.3-2.8% of known deaths among these patients. The risk factors include chronic infection and chronic indwelling catheters(longer than 8 years).

Cytology is a useful adjunct to improve the detection of bladder cancer in spinal cord injured patients with chronic indwelling catheters (>5 years).


Jan, 2001

Note: The information in this article has been excerpted from the following books: urotext-ebook simplifying urology, Principles of modern urology, by Dr. R.A.S HEMAT. Permission is granted to copy and redistribute this document electronically as long as it is unmodified. This article may not be sold in any medium, including electronic, CD-ROM, or database, or published in print, without the explicit, written permission of Dr. R. A. S. Hemat.

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Dr. R.A.S HEMAT declares no conflicts of interest or financial interests in any product or service mentioned in this article, including grants, employment, stock holdings, gifts, or honoraria.

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