Bladder Function Following Spinal Cord Injury: a Urodynamic Analysis of the Outcome

Abstract

Repeated urodynamic testing was undertaken on a group of 58 consecutive patients admitted with acute spinal cord injury. Thirty-seven (64%) were able to void satisfactorily spontaneously, whereas 10 required bladder outlet surgery and 11 achieved emptying by either abdominal straining, intermittent self-catheterisation or an indwelling suprapubic catheter. The pattern of the initial cystometry soon after injury provided some idea of what possibilities could be expected of subsequent bladder function. Very high detrusor pressures exceeding 80 to 100 cm of water developed in a third of patients with supranuclear lesions. Six patients developed vesicoureteric reflux between 4 and 24 months after injury.

A therapeutic trial of acupuncture in neurogenic bladder of spinal cord injured patients – a preliminary report

“…The results were the same as previous reports. 1,2 No signi®cant di erence between upper and lower motor neuron lesion was found. Acupuncture is an important branch of traditional Chinese Medicine.…”

“…However, it usually takes two to three months of bladder training to reach balanced status, and only about two thirds can reach balanced bladder by conventional bladder program. 1,2 Although clean intermittent catheterization was considered as a safe technique for long term management of voiding disorders, owing to the high humidity climate and running water system here in Taiwan, most of our patients would prefer to have catheter-free voiding as soon as possible, especially at home.…”

Anorectal physiology following spinal cord injury

“…Incontinence did not aect the every day activities of anyone with manometry of Patterns 1, 2, or 3, and only occasionally for Pattern 4. Table 6 shows the distribution of cystometry patterns 3 for each anorectal manometry pattern. The cystometrogram was abnormal in all cases.…”

“…The volume pressure curve is useful as it describes detrusor function and coordination with the urethral sphincter. 3 Pattern F is a normal detrusor re¯ex with bladder ®lling resulting in very little change in pressure and on voluntary initiation of¯ow, intravesical pressure rises smoothly until the bladder empties. Pattern A shows a sustained detrusor contraction, but the implication from the high intravesical pressure is that there is a constant urethral resistance.…”

“…Interpretation of these results was according to patterns described by Arnold et al 3 The pattern of cystometrogram can be classi®ed as outlined in Figure 1. The volume pressure curve is useful as it describes detrusor function and coordination with the urethral sphincter.…”