The elderly para- and tetraplegic: special aspects of the urological care.

This paper evaluates the influence of age on bladder rehabilitation and the incidence of secondary changes in the urinary tract with long standing paraplegia and tetraplegia and its consequences for the elderly patient. It demonstrates that age makes bladder rehabilitation in these patients more difficult, because of the decreased ability of the elderly to cope with the new situation, of pre-existing factors interfering with micturition like benign prostatic hyperplasia and cystocele and because of a delayed and at the end sometimes weak detrusor reflect activity. Long standing paraplegia is characterised by a high percentage of secondary structural changes in the lower urinary tract, especially at the bladder outlet. Once these changes are established the outflow resistance is further increased. These findings stress the need for early adequate management of the functional outflow obstruction based on careful urodynamic evaluation, before secondary structural changes occur. In this connection it is pointed out, that passive voiding by abdominal straining or by the Crede technique may cause unphysiologically high intravesical and intra-abdominal pressures and should then be replaced by intermittent catheterisation.