The assessment of bladder and urethral function in spinal cord injury patients

Abstract

The correlation between the anatomic site of spinal cord injury and real-time conditions of bladder and urethral function was assessed in order to provide a reasonable basis for the clinical treatment of neurogenic bladder. A total of 134 patients with spinal cord injuries (105 males, 29 females; averaged 34.1 years old) were involved in this retrospective analysis, including urodynamic evaluation, clinical examination and imaging for anatomical position, and Bors-Comarr classification. The associations between the levels of injury and urodynamic findings were analyzed. The results showed that mean follow-up duration was 16.7 months (range 8–27 months). Complete spinal cord injuries occurred in 21 cases, and incomplete spinal cord injuries in 113 cases. Of the 43 patients with upper motor neuron (UMN) injuries, hyperreflexia and (or) detrusor sphincter dyssynergia were demonstrated in 30 (69.8%), 31 (72.1%) suffered low bladder compliance (less than 12.5 mL/cmH₂O), 28 (65.1%) had high detrusor leak point pressures (greater than 40 cmH₂O), and 34 (79.1%) had residual urine. Of the 91 patients with lower motor neuron (LMN) injuries, areflexia occurred in 78 (85.7%), high compliance in 75 (82.4%), low leak point pressures in 80 (87.9%), and residual urine in 87 (95.6%), respectively. The associations between the anatomical site of spinal cord injury and urodynamic findings were ill defined. In patients with spinal cord injury, this study revealed a significant association between the level of injury and the type of voiding dysfunction. The anatomical site of spinal cord injury can not be predicted in real-time condition of bladder and urethral function. Management of neurogenic bladder in patients with spinal cord injury must be based on urodynamic findings rather than inferences from the neurologic evaluation.

Keywords

spinal cord injury / neurogenic bladder / urodynamics

References

[1] ZhangX.J., QianS.Q., MengQ.X., et al.. Complication and prevention situation of neurogenic baldder after spinal cord injury. Shiyong Yiyao Zazhi (Chinese), 2008, 25(4): 480-483

[2] FonteN.. Urological care of the spinal cord-injured patient. J Wound Ostomy Continence Nurs, 2008, 35(3): 323-331

[3] ChenZ.. Rehabilitation therapy of neurogenic lower urinary tract dysfunction. Zhongguo Wuli Yixue Yu Kangfu Yixue Zazhi (Chinese), 2008, 30(3): 213-215

[4] SamsonG., CardenasD.D.. Neurogenic bladder in spinal cord injury. Phys Med Rehabil Clin N Am, 2007, 18(2): 255-274

[5] MiddletonJ.W., LeongG., MannL.. Management of spinal cord injury in general practice. Aust Fam Physician, 2008, 37(4): 229-233

[6] ZengW.P., HuangN.R., LuC.X.. Voiding dysfunction in patients with traumatic paraplegia rehabilitation training experience of 71 cases. Guangxi Yixue (Chinese), 2008, 30(11): 1794-1795

[7] HaoD.J., HeL.M., YuanF.Y.. Late complications in patients with spinal cord injury and related factors. Zhongguo Jizhu Jisui Zazhi (Chinese), 2005, 15(5): 267-270

[8] KuJ.H.. The management of neurogenic bladder and quality of life in spinal cord injury. BJU Int, 2006, 98(4): 739-745

[9] StöhrerM., Castro-DiazD., Chartier-KastlerE., et al.. Guidelines on neurogenic lower urinary tract dysfunction. Prog Urol, 2007, 17(3): 703-755

[10] MoslavacS., DzidicI., KejlaZ.. Neurogenic detrusor over-activity: comparison between complete and incomplete spinal cord injury patients. Neurourol Urodyn, 2008, 27(6): 504-506

[11] XiongZ.S., XuZ.Y.. Urodynamic study and classification of the bladder after spinal cord injury. Xiandai Kangfu (Chinese), 2000, 4(6): 805-807

[12] LiuZ., ZhangL.R., HeP., et al.. Significance of urodynamic analysis in the diagnosis and evaluation of thoracolumbar spinal injury. Zhongguo Linchuang Kangfu Zazhi (Chinese), 2005, 9(33): 34-35

[13] ShinJ.C., ChangW.H., JungT.H., et al.. The determination of sensation-dependent bladder emptying time in patients with complete spinal cord injury above T11. Spinal Cord, 2008, 46(3): 210-215

[14] HanC.S., DaiF.J., ZhouG.C.. Urodynamics of neurogenic lower urinary tract disfunction caused by spinal cord injury. Zhonghua Waike Zazhi (Chinese), 2002, 40(6): 411-414

[15] SchurchB., SchmidD.M., KarsentyG., et al.. Can neurologic examination predict type of detrusor sphincter-dyssynergia in patients with spinal cord injury. Urology, 2005, 65(2): 243-246

[16] ChuaH.C., TowA., TanE.S.. The neurogenic bladder in spinal cord injury—pattern and management. Ann Acad Med Singapore, 1996, 25(4): 553-557

[17] WeldK.J., DmochowskiR.R.. Association of level of injury and bladder behavior in patients with post-traumatic spinal cord injury. Urology, 2000, 55(3): 490-494

[18] NosseirM., HinkelA., PannekJ.. Clinical usefulness of urodynamic assessment for maintenance of bladder function in patients with spinal cord injury. Neurourol Urodyn, 2007, 26(2): 228-233

[19] KalitaJ., ShahS., KapoorR., et al.. Bladder dysfunction in acute transverse myelitis: magnetic resonance imaging and neurophysiological and urodynamic correlations. J Neurol Neurosurg Psychiatry, 2002, 73(1): 154-159

[20] ChouF.H., HoC.H., ChirM.B., et al.. Normal ranges of variability for urodynamic studies of neurogenic bladders in spinal cord injury. J Spinal Cord Med, 2006, 29(1): 26-31