Factors associated with ultrasound diagnosed neurogenic bladder complications following spinal cord injury.

INTRODUCTION: Neurogenic bladder (NB) is a recognized secondary medical impairment following spinal cord injury (SCI). Ultrasound (US) of the kidneys, ureters and bladder (KUB) has been recommended as a useful, non-invasive surveillance method with good diagnostic sensitivity. This study aims to understand US diagnosed NB complications and identify its associated factors. METHODS: We enrolled all patients referred for SCI rehabilitation from 2012 to 2015 that fulfilled our study criteria. Data that were retrospectively reviewed included demographic and clinical characteristic data; and US KUB surveillance studies. RESULTS: Out of 136 electronic medical records reviewed, 110 fulfilled the study criteria. The prevalence of NB in our study population was 80.9%. We found 22(20%) of the patients showed evidence of US diagnosed NB complications with the mean detection of 9.61±7.91 months following initial SCI. The reported NB complications were specific morphological changes in the bladder wall 8(36.4%); followed by unilateral/bilateral hydronephrosis 7(31.8%); bladder and/or renal calculi 5(22.7%); and mixed complication 2(9.1%) respectively. Half of the patients with NB complications had urodynamic diagnosis of neurogenic detrusor overactivity with/without evidence of detrusor sphincter dyssynergia. We found co-existing neurogenic bowel, presence of spasticity and mode of bladder management were significantly associated factors with US diagnosed NB complications (p<0.05), while spasticity was its predictor with adjusted Odds Ratio value of 3.93 (1.14, 13.56). CONCLUSION: NB is a common secondary medical impairment in our SCI population. A proportion of them had US diagnosed NB complications. Co-existing neurogenic bowel, presence of spasticity and mode of bladder management were its associated factors; while spasticity was its predictor.

Papase as a treatment option for the overgranulating wound.

Overgranulation (also commonly known as hypergranulation) is a common problem in chronic wound management. We describe a case involving a 57-year-old lady with a chronic diabetic foot ulcer, complicated with overgranulation for the past year. She was administered with various treatments, including hydrocortisone 1% cream and hydrofiber, which proved ineffective and further delayed the healing process of her ulcer. We then decided to use crushed Papase tablets applied to her ulcer after a normal saline dressing and prior to an application of secondary dressing. The patient was instructed clearly on the dressing technique to be performed daily at home and was monitored weekly in a foot care clinic. The overgranulation resolved within 5 weeks and the patient continues recieving care to promote epithelialisation.