Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Oct 16, 2021; 9(29): 8946-8952
Published online Oct 16, 2021. doi: 10.12998/wjcc.v9.i29.8946
Disruption of sensation-dependent bladder emptying due to bladder overdistension in a complete spinal cord injury: A case report
Ju-Yul Yoon, Da-Sol Kim, Gi-Wook Kim, Yu Hui Won, Sung-Hee Park, Myoung-Hwan Ko, Jeong-Hwan Seo
Ju-Yul Yoon, Department of Physical Medicine and Rehabilitation, Jeonbuk National University Medical School, Jeonju 54097, Jeonbuk, South Korea
Da-Sol Kim, Gi-Wook Kim, Yu Hui Won, Sung-Hee Park, Myoung-Hwan Ko, Jeong-Hwan Seo, Department of Physical Medicine and Rehabilitation, Jeonbuk National University Medical School, Korea Research Institute of Clinical Medicine of Jeonbuk National University − Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju 54097, Jeonbuk, South Korea
Author contributions: Seo JH contributed to the concept; Kim DS, Kim GW, and Won YH contributed to the design of the study and acquisition of data; Park SH and Ko MH contributed to the analysis and interpretation of data; Seo JH and Yoon JY contributed to the drafting of the article and revising it critically for important intellectual content; all authors have read and approved the final manuscript.
Informed consent statement: Informed written consent was obtained from the patient for the publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jeong-Hwan Seo, MD, PhD, Professor, Department of Physical Medicine and Rehabilitation, Jeonbuk National University Medical School, Korea Research Institute of Clinical Medicine of Jeonbuk National University − Biomedical Research Institute of Jeonbuk National University Hospital, Geonjiro 20, Deokjin-gu, Jeonju 54097, Jeonbuk, South Korea. vivaseo@jbnu.ac.kr
Received: July 10, 2021
Peer-review started: July 10, 2021
First decision: July 26, 2021
Revised: July 27, 2021
Accepted: August 18, 2021
Article in press: August 18, 2021
Published online: October 16, 2021
Processing time: 97 Days and 0.9 Hours
Abstract
BACKGROUND

Autonomic dysreflexia (AD) can be a life-threatening condition in patients with spinal cord injury. It is important to prevent bladder overdistension in these patients as it may trigger AD. Sensation-dependent bladder emptying (SDBE), as a method of bladder management, improves the quality of life and allows physiologic voiding. In this study, we report disruption of the SDBE habit after bladder overdistension leading to AD with chest pain.

CASE SUMMARY

A 47-year-old male with a diagnosis of C4 American Spinal Cord Injury Association impairment scale A had been emptying his bladder using the clean intermittent catheterization method with an itchy sensation in the nose as a sensory indication for a full bladder for 23 years, and the usual urine volume was about 300-400 mL. At the time of this study, the patient had delayed catheterization for approximately five hours. He developed severe abdominal pain and headache and had to visit the emergency room for bladder overdistension (800 mL) and a high systolic blood pressure (205 mmHg). After control of AD, a hypersensitive bladder was observed despite using anticholinergic agents. The sensation indicating bladder fullness changed from nose itching to pain in the abdomen and precordial area. Moreover, the volume of the painful bladder filling sensation became highly variable and was noted when the bladder urine volume exceeded only 100 mL. The patient refused intermittent clean catheterization. Finally, a cystostomy was performed, which relieved the symptoms.

CONCLUSION

Patients using physiologic feedback, such as SDBE, for bladder management are recommended to avoid bladder overdistension.

Keywords: Neurogenic bladder; Sensation-dependent bladder emptying; Spinal cord injury; Autonomic dysreflexia; Bladder overdistension; Bladder management; Case report

Core Tip: In this report, sensation-dependent bladder emptying (SDBE), which had been maintained for 23 years, was disrupted after bladder overdistension that led to autonomic dysreflexia (AD) in a patient with complete spinal cord injury (SCI). After the AD due to bladder overdistension, the bladder was oversensitive to even a small amount of urine, resulting in unbearable discomfort. Cystostomy was later performed. Patients using physiologic feedback, such as SDBE, for bladder management should follow a strict bladder emptying regimen. In addition, by considering the effect of AD on bladder filling sensation in this case, we provide additional information about the mechanism of AD and "discomplete SCI.”