Investigation of the afferent nerves of the lower urinary tract in patients with ‘complete’ and ‘incomplete’ spinal cord injury

Wyndaele, Jean Jacques

doi:10.1038/sc.1991.67

Cited by 30 publications

(39 citation statements)

References 14 publications

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“…Further, rectal stimulation showed cortical activation in areas of the brain similar to healthy volunteers. Their assertion is supported by other studies in which SCI patients describe sensation in the bladder, 12,13 genital stimulation 14 and anorectal sensation. 15,16 In another study using MRI, Samdani et al 17 describes a patient who was clinically tested as incomplete, but had complete disruption of their spinal cord.…”

Section: Discussionsupporting

confidence: 64%

The international standards for neurological classification of spinal cord injury: relationship between S4-5 dermatome testing and anorectal testing

et al. 2010

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Study design: Prospective cross-sectional multicenter study. Objective: To evaluate the correlation, sensitivity, specificity and predictive values of S4-5 dermatome and the anorectal examination for determination of sacral sparing in the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) examination. Setting: Two tertiary hospitals that specialize in pediatric spinal cord injuries. Methods: In all, 189 patients who were at minimum 3 month after spinal cord injury participated in complete ISNCSCI examinations. All examiners completed training for the proper completion of the ISNCSCI examination. Correlations and sensitivity/specificity analyses were conducted between S4-5 dermatome testing and the anorectal examination. Results were analyzed by age of patient, examiner, tetraplegia/paraplegia classification and injury level (T10-S3, L1-S3 and S3). Results: The correlation between S4-5 dermatome and anorectal sensation was moderate (0.62, Po0.001). Using the anorectal examination as the gold standard, the sensitivity of S4-5 testing was 0.60 (0.49, 70) and specificity was 0.96 (0.90, 0.99). No single age group, tester, level, or type of injury differed from the overall result. Conclusion: In the pediatric population, the correlation between S4-5 and anorectal sensation was lower than anticipated. The sensitivity of 0.62 for S4-5 testing and diminished sensation between T10 and S3 suggests that anorectal testing may either be a more sensitive representation of S4-5 function or activate an alternative neuronal pathway that is perceived by the patient. Further investigation into the validity of the sacral sparing components of the ISNCSCI examination is warranted.

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Section: Discussionsupporting

confidence: 64%

The international standards for neurological classification of spinal cord injury: relationship between S4-5 dermatome testing and anorectal testing

et al. 2010

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“…18 From our data it would seem advisable that completeness of a spinal cord lesion should only be accepted after evaluation of LUT sensation. 10 The bulbocavernosus re¯ex extends from L5 to S5, the anal re¯ex arc being also in the lower sacral segments. Investigating these re¯exes will theoretically inform about the preservation or damage of the lower spinal cord and thus about the innervation of bladder and striated sphincter.…”

Section: Discussionmentioning

confidence: 99%

“…9 Evaluation of the a erent innervation of the LUT was performed with the determination of ®lling sensation and in a limited number of patients with the determination of the thresholds for electrical stimulation. 10 The following urodynamic diagnoses are used: for the detrusor: normal (=volitional start of micturition), hyperre¯exic, are¯exic; for the bladder neck: dyssynergic (=not opening at detrusor contraction), synergic (=opening at detrusor contraction), incompetent (=always open); for the urethral striated sphincter: synergic, dyssynergic (including non relaxing and intermittently relaxing during micturition), incompetent (=¯accid paralysis). Most of these follow the de®nitions as proposed by the International Continence Society.…”

Section: Methodsmentioning

confidence: 99%

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

Wyndaele

1997

Spinal Cord

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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.

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“…During the investigation of the neurogenic bladder in discomplete SCIs, Wyndaele 11 reported that 15 of the 42 patients with a lesion diagnosed clinically as complete, perceived bladder filling, indicated the existence of an afferent nerve pathway between the lower urinary tract and the cerebral cortex. Ersoz and Akyuz 26 reported that 6 of the 18 patients with complete SCIs above T11 had preserved the bladder-filling sensations, and sensation-dependent bladder emptying was possible in these patients because the bladder capacity and the detrusor pressure at the preserved bladder-filling sensation were, respectively, greater than 150 ml and less than 40 cm H 2 O.…”

Section: Discussionmentioning

confidence: 99%

“…10 Although theoretically, a patient with a complete SCI above T11 is not able to transfer the desire to void from the bladder to the brain, some patients often express a weak desire to void or a different desire to void compared with their desire to void before their SCIs. In 1991, Wyndaele 11 reported the existence of an afferent nerve pathway between the lower urinary tract and the cerebral cortex in 15 of 42 patients with complete SCIs. In 2006, we reported that there were 37 (31.6%) of 117 complete SCI patients with lesions above T11 with preservation of the desire to void.…”

Section: Introductionmentioning

confidence: 99%

The determination of sensation-dependent bladder emptying time in patients with complete spinal cord injury above T11

et al. 2007

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Study design: Retrospective investigation using urodynamic studies and medical records. Objective: To evaluate the safety of sensation-dependent bladder emptying in complete spinal cord injury (SCI) patients, based on the preservation of the desire to void. Setting: Spinal Cord Injury Unit, Yonsei Rehabilitation Hospital, Seoul, Korea. Methods: This study was performed retrospectively on 79 complete SCI patients with lesions above T11, who had preserved the desire to void during conventional urodynamic studies. Patients were classified according to detrusor compliance and maximal bladder capacity. The clinical and urodynamic characteristics of each group were analyzed. Results: Forty-five (57.0%) patients were classified as group A and 34 (43.0%) patients were classified as group B. There were no significant differences in clinical features, such as voiding methods and the presence of autonomic dysreflexia between the two groups. Compared with group B, there were significantly more areflexic neurogenic bladder cases in group A (Po0.05). There were significantly higher maximal detrusor pressures in group B (Po0.05). There were significantly more cases with the preservation of the strong desire to void in group B (Po0.05). Conclusion: Not all patients with discomplete SCIs accepted the use of sensation-dependent bladder emptying. The safe use of sensation-dependent bladder emptying will be determined based on the results of urodynamic studies.

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Investigation of the afferent nerves of the lower urinary tract in patients with ‘complete’ and ‘incomplete’ spinal cord injury

Cited by 30 publications

References 14 publications

The international standards for neurological classification of spinal cord injury: relationship between S4-5 dermatome testing and anorectal testing

The international standards for neurological classification of spinal cord injury: relationship between S4-5 dermatome testing and anorectal testing

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

The determination of sensation-dependent bladder emptying time in patients with complete spinal cord injury above T11

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