A comparative analysis of biochemical parameters of blood serum and daily urine in patients with urolithiasis developed after spinal cord injury (study group--35 patients) and patients without development of the disease (comparison group--20 patients) was performed. It was found that patients after spinal cord injury have developed productive azotemia, which led to the disruption of renal excretory function (accumulation of urea and creatinine in blood, and lowering their clearance). Against this background, there is violation of excretion of uric acid, magnesium, decreased sensitivity of the renal tubules to aldosterone (in patients with nephrolithiasis K/Na ratio in urine was lower). As a result, patients have decreased reabsorption of sodium and water retention, increased urine osmolality; against the background of electrolyte imbalance in urine, this leads to the formation of stones. In patients with spinal cord injuries, main trigger mechanism of formation of urinary stones was excessive posttraumatic azotemia. The high concentration of the products of protein-nitrogen catabolism in the serum of patients in the acute and early periods of spinal cord injury may be unfavorable criterion determining the significant risk of developing of kidney stones.
The study of the urinary system condition has been performed in 31 patients with spine-and-spinal cord injuries using ultrasonography and excretory urography. The diffuse changes in the kidneys, the presence of concrements, the dilatation and deformation of the renal pelvicaliceal system, as well as the decrease of renal accumulative and excretory function has been revealed in the patients of this category. The thickening of urinary bladder wall, structural heterogeneity, the presence of suspension in the urinary bladder cavity was observed too. And, besides, the increase of prostate volume with vesiculitis signs.
Целью работы являлось исследование функциональных возможностей мочевыделительной системы с помощью экскреторной урографии у больных с позвоночно-спинномозговой травмой. Изучение состояния мочевыделительной системы проведено у 48 больных с позвоночно-спинномозговой травмой в шейном, грудном, грудопоясничном отделах на разных этапах развития травматической болезни спинного мозга (в остром, раннем, промежуточном и позднем периодах). Основным методом исследования была экскреторная урография. У больных с позвоночно-спинномозговой травмой в шейном, грудном и грудопоясничном отделах выявлено снижение накопительной и выделительной функции почек, определены негативные структурные изменения органов мочевыделительной системы, способствующие развитию воспалительных изменений (расширение и деформация чашечно-лоханочной системы, наличие конкрементов, изменение формы мочевого пузыря) и имеющие большую степень выраженности у больных с позвоночно-спинномозговой травмой в промежуточном и позднем периодах. При позвоночно-спинномозговой травме, в связи с нарушением нервной регуляции органов мочевыделительной системы, гиподинамии, происходит развитие компенсаторных явлений со стороны мочевыделительной системы. Функция почек сохраняется, однако наблюдается снижение функциональных возможностей накопления и выделения мочи. Данные явления способствуют застойным явлениям, формированию мочевых камней, гнойно-септическим осложнениям в органах мочевыделения.
The study of the urinary system condition has been performed in 31 patients with spine-and-spinal cord injuries using ultrasonography and excretory urography. The diffuse changes in the kidneys, the presence of concrements, the dilatation and deformation of the renal pelvicaliceal system, as well as the decrease of renal accumulative and excretory function has been revealed in the patients of this category. The thickening of urinary bladder wall, structural heterogeneity, the presence of suspension in the urinary bladder cavity was observed too. And, besides, the increase of prostate volume with vesiculitis signs.
The ultrasound examination of the urinary system state has been performed in 55 patients with spine-and-spinal cord injuries (SSCI) in the acute, intermediate and late periods of the course of spinal cord traumatic disease. It has been established by the results of examinations that diffuse changes in renal parenchyma, dilatation and deformation of the renal pelvicaliceal system (PCS), the presence of concrements, thickening and heterogeneity of the bladder wall structure, the presence of suspension in the bladder cavity, the increase of prostate volume with vesiculitis signs is observed in the patients of this category. The above-mentioned changes have been revealed mainly in the late period of SSCI in patients with the motor and sensory disorders present.
Characteristics of urinary tract microflora in patients with spinal cord injury Bludenov D.N., Naumenko Z.S., Godovyh N.V., Prudnikova O.G., Shchurova E.N. Federal State Budget Institution – The Russian Ilizarov Scientific Center Restorative Traumatology and Orthopaedics of the Ministry of Health and Social Development of Russia, Kurgan, Russia. (640014, Kurgan, street M. Ulyanova, 6) e-mail: dimon4581@inbox.ru A hospital-based study was conducted and urine samples were collected from 42 clinical cases of spinal cord injury and tested bacteriologically using standard procedures. Urinary tract infections were detected from 78.6% of the total patients. The predominant pathogens isolated belong to Enterobacteria group. Correlation between species of uropathogens isolated and micturion in patients as well as antibiotic resistance of bacteria were analysed. Enterobacteria (E. colli, K. pneumoniae), isolated from patients with urine bradyuria, incontinence or epicystosome were shown to have high resistance to antibiotics, caused by extended-spectrum-B-lactamase production (ESBL). Microbial profile did not depend on the kind of moving disorders, however, the frequency of isolation of pathogens was the lowest in patients with spastic paraparesis of lower limbs.
The ultrasound examination of the urinary system state has been performed in 55 patients with spine-and-spinal cord injuries (SSCI) in the acute, intermediate and late periods of the course of spinal cord traumatic disease. It has been established by the results of examinations that diffuse changes in renal parenchyma, dilatation and deformation of the renal pelvicaliceal system (PCS), the presence of concrements, thickening and heterogeneity of the bladder wall structure, the presence of suspension in the bladder cavity, the increase of prostate volume with vesiculitis signs is observed in the patients of this category. The above-mentioned changes have been revealed mainly in the late period of SSCI in patients with the motor and sensory disorders present.
