Comparison of urodynamic findings in patients with upper and lower cervical spinal cord injury

Abstract

Study design: Retrospective study.Objectives: To analyze the neurogenic bladder characteristics and treatment approaches in patients with upper and lower cervical spinal cord injury (SCI) in order to make proper and reasonable decisions to the relevant patients. Setting: Rehabilitation center in Ankara, Turkey. Method: Ninety patients with cervical SCI were included. The urodynamic analyses of the patients were conducted retrospectively by using the urodynamic laboratory records. The patients were divided into two groups as the upper cervical SCI (UCSCI) group (C1-C5) and lower cervical SCI (LCSCI) group (C6-C8). Results: In this study, 82 male (91.1%) and 8 (8.9%) female patients were included. There were 51 UCSCI patients with the mean age of 34.2 ± 16.1 years and 39 LCSCI patients with the mean age of 30.4 ± 12.5 years. Detrusor overactivity and preservation of the bladder-filling sensation were significantly more frequent in the UCSCI group than in the LCSCI group (P ¼ 0.048, P ¼ 0.000 respectively). Moreover, there were statistically significant differences between the groups regarding the bladder-emptying methods, residual volume and the frequency of anticholinergic and alpha blocker use (all Po0.05). No significant difference was found between the groups regarding the frequency of autonomic dysreflexia, detrusor hypocompliancy and the bladder-storage and -emptying disorders (all P40.05). INTRODUCTIONSpinal cord injury (SCI) is a disease that is resulted by traumatic or nontraumatic reasons, and it causes restriction of self-care, mobilization and daily activities of the patients to a considerable degree. The SCI incidence was reported to be 15-40 per million. 1,2 The damage as a result of this injury not only limits the movement of the patient but also causes vital changes in the functions of many organs and lead to life-threatening complications. The aforementioned problems are more severe in cases of cervical SCI. Neurogenic bladder is commonplace in SCI patients. It decreases life span and adversely affects the quality of life. [3][4][5][6] Although the neurogenic bladder was one of the most important cause of morbidity/mortality in SCI patients in the past when the examination and treatment were not sufficiently developed, it has reached to a curable level today as a result of new developments.The purpose of this study was to analyze the neurogenic bladder characteristics and treatment approaches retrospectively in the cervical SCI cases by using the urodynamic records of our hospital. As there were some differences in the functional abilities like hand function, sitting balance, and so on in upper (C1-C5) and lower (C6-C8) cervical SCI patients, we hypothesized that neurogenic bladder characteristics and treatment approaches would also differ in these groups. The aim of this study was to make proper and reasonable decisions for the neurogenic bladder treatment approaches in relevant patients with cervical SCI.

Autonomic dysreflexia and repeatability of cardiovascular changes during same session repeat urodynamic investigation in women with spinal cord injury

“…However, UDI may elicit AD. Episodic blood pressure measurement has often been used during UDI to record AD [13,[17][18][19], but although continuous cardiovascular monitoring seems more accurate, since it may reveal even short episodes of AD, only one retrospective study [9] is available. Moreover, repeatability of cardiovascular changes during same session repeat UDI is unknown, and there is a complete lack of women-specific AD data.…”

Iatrogenic urological triggers of autonomic dysreflexia: a systematic review

“…24 However, no significant difference was found regarding the frequencies of AD between C1-C5 and C6-C8 groups. 26 Giannantoni et al 15 found no correlation of AD to gender, age, disease duration or completeness of SCI. Huang et al 24 similarly showed no correlation of BP changes in relation to completeness of injury.…”

“…The incidence of AD during urodynamics varied [15][16][17]21,[23][24][25][26] ranging from 36.7% to 77.8%. This variation was influenced primarily by the neurological level and severity of the SCI.…”

“…Most studies 17,21,[23][24][25]33,34,41,44 used BP changes as the criteria, whereas some studies 15,16,39 used maximal BP as the criteria. One study 26 used both of these indicators. In the studies using SBP changes, the criteria varied from 10 to 50 mm Hg, whereas only three studies 24,25,34 published after 2009 used 20 mm Hg as the criteria, consistent with the ISAFSCI guidelines.…”

Some important points for urodynamic studies

“…On the other hand, prescribed anticholinergic can affect the severe storage and emptying dysfunction of the bladder and improve bladder capacity. [3] Another, effective drug is baclofen, which has a positive effect on the bladder emptying function by relaxing the external sphincter. [4] This drug is commonly used in stroke patients.…”