Neurogenic Bladder in Patients with Cervical Compressive Myelopathy

Abstract

We examined the urinary disturbances in 56 consecutive patients with cervical compressive myelopathy using the latest International Continence Society classification. Of the 56 patients with cervical compressive myelopathy, 29 (52%) had some urinary subjective complaints, whereas the remaining 27 (48%) had none. Urologic examination indicated that 8 of these 29 (28%) patients with urinary complaints had urologic disorders other than neurogenic bladder. Of the remaining 21 patients, only 6 (25%) were judged to have neurogenic bladder on urodynamic study. Urodynamic study may be of limited value in diagnosing urinary disturbance in cervical myelopathy. Further, four cases (83%) showed underactive bladder activity in voiding phase, and only one case (17%) showed overactive bladder activity in filling phase. These results were contrary to those of previous studies indicating that cervical compressive myelopathy is associated with overactive bladder activity in filling phase. There were no significant differences in motor or sensory Japanese Orthopedic Association scores between the patients with and without urinary complaints. However, the patients with urinary complaints had significantly longer durations of myelopathy and delayed motor evoked potential latencies than those without urinary complaints. After surgery, 19 of the 21 (90%) patients with urinary complaints showed recovery from urinary disturbance. Operations in patients with cervical myelopathy were also effective against urinary disturbance. Urinary complaints may be an indication for surgical treatment despite the results of urodynamic study.

Clinical indicators of surgical outcomes after cervical single open-door laminoplasty assessed by the Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire

“…Similarly, Ohya et al used the JOACMEQ to assess cervical OPLL patients who underwent double-door laminoplasty, and found no significant improvement in bladder function [19]. Because several populations with cervical myelopathy may have urologic disorders rather than neurogenic bladder symptoms, urodynamic or other appropriate tests should be used to determine whether other treatments can improve bladder function [41,42]. Otherwise, the indications for laminoplasty should be revisited and other surgical methodologies considered, although there are no comparative studies of the impact of various techniques on bladder function.…”

Assessment of health-related quality of life using the SF-36 in Chinese cervical spondylotic myelopathy patients after surgery and its consistency with neurological function assessment: a cohort study

“…At 3 months after surgery, the SF-36 scores of the patients exhibited significant improvement in only one item (PF), which was not consistent with the significantly improved neurological function observed after surgery. A potential explanation for this result might be that at 3 months after surgery, despite improved neurological function and somewhat improved sensory and motor functions compared with the preoperative conditions, factors such as postoperative wound pain and wound-related restrictions on activities prevented direct reflection of improved neurological function in the patients [ 26 - 29 ]. As wounds healed and the capacity and intent of the patients to participate in social activities increased, the patients exhibited significant improvements in PF, RP, SF, and emotional function at the mid-term and long-term follow-up evaluations compared with the preoperative conditions.…”

Neurogenic lower urinary tract dysfunction in association with severity of degenerative spinal diseases: Short‐term outcomes of decompression surgery

“…Each query is scored from 0 to 5 points, with the total IPSS ranging from 0 (asymptomatic) to 35 (very symptomatic). Total IPSS was then divided into voiding subscores (subscore of voiding symptoms [IPSS-V]: queries [1,3,5,6]) and storage subscores (subscore of storage symptoms [IPSS-S]: queries [2,4,7]) in this study.…”

“…5 Meanwhile, the number of operations increased 3-fold for CM and 10-fold for LCS in 25 years between 1988 and 2012 due to the aging of the population. 6 With these increasingly prevalent degenerative spinal diseases, lower urinary tract symptoms (LUTS) are common, at 47% to 81% in CM [7][8][9][10][11][12] and 41% to 88% in LCS patients, [13][14][15][16] and both diseases reportedly present with storage and voiding symptoms. Major orthopedic symptoms of CM are neck pain, numbness and loss of dexterity of the upper limb, stiffness and sensory loss in the lower limbs, and gait impairment.…”