Attila ANGYAL1, Levente LAKATOS1, László SZABÓ2,3,4
1Department of Rehabilitation, Borsod County University Hospital, Miskolc, Hungary
2Department of Nephrology and Urodynamics, Borsod County University Hospital, Miskolc, Hungary
3Faculty of Health Science, University of Miskolc, Miskolc, Hungary
4Postgraduate Institute of Child Health, University of Debrecen, Miskolc, Hungary
Efficient urination can be affected due to congenital, acquired, anatomical or neurological anomalies. The functioning of the urinary
bladder is controlled by the spinal reflexes, which is made up of sympathetic, parasympathetic and somatic fibers. The urinary retention
and/or incontinence are dependent on the level of the lesion.
Our audit consists of patients who were victims of trauma or had undergone a spinal surgery, and were paraparetic. The urodynamics
study results of these were assessed. These patients were admitted to the Rehabilitation Department, between 2008-2009. The average
age of the patients was 51 years and they did not have a previous history of incontinence or problematic micturation. Following
admission significant urinary retention was noted in these patients, due to which a Foley-catheter had to be used. Following urodynamic
studies (uroflow, cystomanometry, urethral-pressure profile), in 11 cases an increased sphincter tone was detected, therefore alfaadrenergic receptor blockers were initiated. Besides a low-dose of prazosine and/or doxazosine, no case of collapse (syncope) was noted. In 9 cases the urinary catheter could be removed, and spontaneous urination initiated. In these cases significant residue was not present in the bladder and the patients could be discharged in continent state. We could not reach improvement in 2 patients, requiring clean-intermittent catheterization.
The results of our audit reveal that alfa-adrenergic receptor blockers in paraparetic patients with increased sphincter tone can lead to significant improvement in symptoms and prevention of severe urological complications.