Correlation between clinical neurological data and urodynamic function in spinal cord injured patients

Abstract

In 92 patients with spinal cord lesion, out of spinal shock, the data from a clinical neurological examination of the lumbosacral area are compared with the data from a full urodynamic investigation, including evaluation of sensation in the lower urinary tract. A signi®cant correlation can be found between di erent levels of spinal cord lesion, the function of bladder neck and sphincter and the anal bulbocavernosus re¯exes. Higher lesions correspond more with a re¯exic lower urinary tract and somatic motor activity, lower lesions more with are¯exia. With a lesion between thoracic 10 and lumbar 2 as many re¯exic as are¯exic lower urinary tract dysfunctions were found. The presence or absence of perineal sensation of light touch corresponded signi®cantly with the presence or absence of sensation in the lower urinary tract. Detrusor and striated sphincter re¯exia/are¯exia corresponded signi®cantly with the presence/absence of bulbocavernosus and anal re¯exes. Clinical neurological examination gives useful information which acceptably corresponds with the LUT function. However to decide on a detailed individual diagnosis, clinical examination is in our opinion insu cient. Urodynamic tests are needed for a profound evaluation of the function of di erent parts of the lower urinary tract and their interaction.

Diagnostic accuracy of single channel cystometry for neurogenic bladder diagnosis following spinal cord injury: a pilot study

“…These data in combination with information on the level and severity of the SCI will enable clinicians to predict the detrusor and sphincter dysfunction in around 80% of patients. 12 This added information could have been the likely reason for the 100% sensitivity, 93.3% PPV and 100% NPV obtained in our study, which is higher than previous comparison studies of non-NBD. Ouslander et al 7 reported, out of 110 geriatric patients with urinary incontinence diagnosed with detrusor motor instability or hyperreflexia using multi-channel cystometry, a simple cystometry study has 77% sensitivity, 79% specificity and 85% PPV.…”

“…2,12,15 Serious urological complications such as reduced bladder compliance, elevated upper tract pressures, hydronephrosis, vesicoureteral reflux and even renal failure have been associated with improperly managed DSD. 2,12,15 Thus, the role of UDS is critical as it provides not only a confirmatory diagnosis of DSD, additionally it is also able to monitor the outcome of intervention. 15 Therefore, the authors recommended that it is mandatory for all patients with clinical or SCC suspicion of having DSD, to have early UDS for confirmation of diagnosis so that proper bladder management strategies are instituted in a timely manner.…”

Audit of bladder neck resection in spinal cord injured patients

“…Urodynamic studies should be the cornerstone of assessment prior to o ering these procedures. 13 A recognised di culty in the audit was the retrospective nature of the earlier part of it. Our method would have been more precise should we have had access to videourodynamics, which was not available.…”

Conservative treatment of the neuropathic bladder in spinal cord injured patients

“…Urodynamic studies are necessary for a proper evaluation of the function of di erent parts of the LUT and their interaction. 8 Cystometry and other urodynamic tests should be repeated to follow the LUT evolution, to evaluate the e ect of treatment, and to discover, as early as possible, aspects of an unbalanced bladder with risks for the upper urinary tract. 9 Madersbacher et al 10 have standardized the various types of neuropathic bladder dysfunction.…”