Neurogenic bladder dysfunction in patients with neoplastic spinal cord compression: Adaptation of the bladder management strategy to the underlying disease
Affiliations: [a] Department of Urology, University of Heidelberg, Germany | [b] Department of Orthopedic Surgery II, Spinal Cord Injury Center, University of Heidelberg, Germany
Correspondence:
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Address for correspondence: André Reitz, M.D., Department of Urology, University of Heidelberg, 69120 Heidelberg, Germany. Tel.: +49 6221566110; Fax: +49 6221566110; E-mail: areitz@gmx.ch
Abstract: Objectives:To study the outcome of different bladder management strategies in patients with neoplastic spinal cord compression. Methods:22 patients with neoplastic spinal cord compression underwent urodynamic examination. According to the urodynamic data and the underlying disease different bladder management strategies were recommended. In patients with curatively treated disease a full bladder rehabilitation program was arranged. In patients with metastatic malignant disease, voluntary voiding was continued if possible or a suprapubic catheter was placed. Results:Eight patients were treated with curative intention. Of those, 2 patients were able to void during urodynamics continued normal voluntary voiding. Six patients were taught intermittent catheterisation, with three additionally received oral anticholinergic treatment because of UMN lesion. At follow-up, all patients had successfully finished bladder rehabilitation program and at follow up, all patients were continuing their previously recommended bladder rehabilitation program. Fourteen patients had malignant disease and were treated palliatively. In 2 patients with UMN lesion, voluntary control of micturition was maintained and both continued voluntary voiding. In 12 patients a suprapubic catheter was inserted. At follow-up, 9 out of 14 had died (mean 8 month after primary visit), the remaining 5 continued treatment with suprapubic catheters. Conclusion:Underlying disease and life expectancy should be considered for the selection of bladder management in patients with neoplastic spinal cord compression. In patients with curatively treated disease, a full bladder rehabilitation program is recommended while in patients with malignant disease and palliative care, a suprapubic catheter might be the treatment of choice.
