Expert opinion on surgical care pathway management of neurologic patients from Neuro-Urology Committee of the French National Association of Urology (AFU)

• Published in: Progrès en urologie (Paris) Vol. 23; no. 5; p. 309
• Main Authors: Caremel, R, Phé, V, Bart, S, Castel-Lacanal, E, De Sèze, M, Duchene, F, Bertrandy-Loubat, M, Mazerolles, M, Scheiber-Nogueira, M C, Karsenty, G, Gamé, X
• Format: Journal Article
• Language: French
• Published: France 01-04-2013
• Subjects: Anesthesia - standards; Critical Pathways; Humans; Nervous System Diseases - complications; Postoperative Care; Preoperative Care; Urologic Diseases - etiology; Urologic Diseases - surgery; Urologic Surgical Procedures - standards
• ISSN: 1166-7087
• DOI: 10.1016/j.purol.2012.11.006

The surgical care pathway of neurologic patients has two aims: preventing urinary morbidity and mortality and improving their quality of life. It requires taking into account the specificities of disabilities in domains of body functions: circulatory, ventilation and digestive physiology, motor functions, sensory functions, mental functions, and skin fragility which are responsible of dependencies in this heterogeneous group of patients. This management is necessarily multidisciplinary to be optimal and through specific clinical care pathway, providing guidance to the surgical procedure: preparation of the surgery, its realization, and post-operative rehabilitation. The indication for surgery must be coordinated and validated in neuro-urology multidisciplinary staff. Preoperative stay in a physical and rehabilitation medicine center may be useful to ensure a complete assessment and anticipate problems related to surgery. The patient will be hospitalized in the urology department in a single room suited to their disabilities and handicaps. The chronic treatments should be not modified if possible. The lack of sensitivity does not dispense anesthesia to prevent autonomic hyperreflexia, the most severe complication after high complete spinal cord injury. The laparoscopy and sub-peritoneal surgery, the early removal nasogastric tube and early refeeding make it possible to early resumption of intestinal transit. In many cases, the patients should be transferred to a physical and rehabilitation medicine during post-operative period where the nursing care will be most suitable. A quickly adapted rehabilitation must be able to reduce loss of function and physical dependence.