Weld K J, Dmochowski R R
Department of Urology, University of Tennessee, Memphis, Memphis, Tennessee, USA.
Urology. 2000 Apr;55(4):490-4. doi: 10.1016/s0090-4295(99)00553-1.
The expected urodynamic findings of patients with suprasacral and sacral spinal cord injury have previously been reported. However, the associations between the radiographically determined level or levels of injury and urodynamic findings are ill defined. This study investigated these relationships, specifically the bladder behavior of patients with post-traumatic spinal cord injury with combined suprasacral and sacral injuries.
A retrospective review of the patient records, spinal imaging studies, and video-urodynamic studies of 316 patients with post-traumatic spinal cord injury was performed. Of these patients, 243 had complete spinal computed tomography or magnetic resonance imaging studies and constitute the study population. Patients were categorized by the radiographically determined level or levels of injury, clinical neurologic level and completeness of injury, and urodynamic findings.
Of the 196 patients with suprasacral injuries, 186 (94.9%) demonstrated hyperreflexia and/or detrusor sphincter dyssynergia, 82 (41.8%) had low bladder compliance (less than 12.5 mL/cm H(2)O), and 79 (40.3%) had high detrusor leak point pressures (greater than 40 cm H(2)O). Of the 14 patients with sacral injuries, 12 (85.7%) manifested areflexia, 11 (78.6%) had low compliance, and 12 (85.7%) had high leak point pressures. Of the 33 patients with combined suprasacral and sacral injuries, urodynamic studies showed 23 with hyperreflexia and/or detrusor sphincter dyssynergia (67.7%), 9 with areflexia (27.3%), 19 (57.6%) with low compliance, and 20 (60.6%) with high leak point pressures.
In patients with a single level of spinal cord injury, this study revealed a significant association between the level of injury and the type of voiding dysfunction. Patients with combined suprasacral and sacral injuries, as identified with precise spinal imaging techniques, had relatively unpredictable urodynamic findings. Management of the urinary tract in patients with spinal cord injury must be based on urodynamic findings rather than inferences from the neurologic evaluation.
既往已报道过骶上和骶段脊髓损伤患者预期的尿动力学检查结果。然而，影像学确定的损伤节段与尿动力学检查结果之间的关联尚不明确。本研究调查了这些关系，特别是创伤后脊髓损伤合并骶上和骶段损伤患者的膀胱行为。
对316例创伤后脊髓损伤患者的病历、脊髓影像学检查和影像尿动力学检查进行回顾性分析。其中，243例患者进行了完整的脊髓计算机断层扫描或磁共振成像检查，构成研究人群。根据影像学确定的损伤节段、临床神经学节段和损伤的完整性以及尿动力学检查结果对患者进行分类。
在196例骶上损伤患者中，186例（94.9%）表现为反射亢进和/或逼尿肌括约肌协同失调，82例（41.8%）膀胱顺应性低（小于12.5 mL/cm H₂O），79例（40.3%）逼尿肌漏尿点压力高（大于40 cm H₂O）。在14例骶段损伤患者中，12例（85.7%）表现为无反射，11例（78.6%）顺应性低，12例（85.7%）漏尿点压力高。在33例骶上和骶段联合损伤患者中，尿动力学检查显示23例有反射亢进和/或逼尿肌括约肌协同失调（67.7%），9例有无反射（27.3%），19例（57.6%）顺应性低，20例（60.6%）漏尿点压力高。
在单节段脊髓损伤患者中，本研究揭示了损伤节段与排尿功能障碍类型之间存在显著关联。通过精确的脊髓成像技术确定的骶上和骶段联合损伤患者，其尿动力学检查结果相对不可预测。脊髓损伤患者的尿路管理必须基于尿动力学检查结果，而非神经学评估推断。
