Introduction

Historically, bladder washouts were used to instil therapeutic reagents directly into the bladder. This practice has expanded to include instillation of solutions that deal with catheter issues such as encrustation or formation of bio-film. They appear to provide a promising strategy for people with long term catheters. These products are readily available to purchase, but there is concern that people are using these solutions without a complete understanding of the purpose for the rinse and without clinical guidance to monitor response to treatment.

Case presentation

These case studies include three people living with spinal cord injury (SCI) who developed severe autonomic dysreflexia (AD) when a catheter rinse was carried out using a particular solution. Each of the cases developed immediate and, in some cases, intractable AD requiring further intervention to resolve symptoms.

Discussion

Catheter-associated urinary tract infection is a significant cause of morbidity and mortality in people living with SCI. Long-term catheters provide a vector for opportunistic micro-organisms to form bio-film and create an environment that promotes formation of struvite calculi, thus increasing the risk of chronic catheter blockage and urinary tract infection. Whilst these solutions are used to reduce these risks, they also pose additional risks to people susceptible to AD. These cases highlight the need for judicious patient selection and clinical oversight and management of adverse events when using catheter rinse solutions in certain people living with SCI. This is supported by a decision-making algorithm and a response to AD algorithm.

This case report was prepared following the CARE Guidelines (supplementary file 1).

中文翻译：

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三人在滴注 Uro-Tainer® 聚己缩酰胺 0.02% 后出现顽固性自主神经反射异常的病例报告

介绍

历史上，膀胱冲洗被用来将治疗试剂直接注入膀胱。这种做法已扩展到包括滴注解决导管问题（例如结垢或生物膜形成）的解决方案。它们似乎为长期留置导管的人提供了一种有前途的策略。这些产品很容易购买，但令人担忧的是，人们在使用这些解决方案时没有完全了解冲洗的目的，也没有临床指导来监测治疗反应。

案例展示

这些案例研究包括三名脊髓损伤 (SCI) 患者，当使用特定溶液冲洗导管时，他们出现了严重的自主神经反射障碍 (AD)。每个病例均立即发展为AD，在某些情况下发展为顽固性AD，需要进一步干预以解决症状。

讨论

导管相关尿路感染是 SCI 患者发病和死亡的重要原因。长期导尿管为机会微生物形成生物膜提供了载体，创造了促进鸟粪石结石形成的环境，从而增加了慢性导尿管堵塞和尿路感染的风险。虽然这些解决方案用于降低这些风险，但它们也给易患 AD 的人带来了额外的风险。这些病例凸显了在某些 SCI 患者使用导管冲洗溶液时需要明智地选择患者、临床监督和不良事件管理。这是由决策算法和对 AD 算法的响应来支持的。

本病例报告是根据 CARE 指南（补充文件 1）编写的。