Chen Zhong, Sun Shuangquan, Deng Rongjin, Cai Dan, Yuan Xiaoyi, Du Guanghui, Yang Weimin, Ye Zhangqun
Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
J Huazhong Univ Sci Technolog Med Sci. 2009 Oct;29(5):609-13. doi: 10.1007/s11596-009-0515-4. Epub 2009 Oct 11.
The correlation between the anatomic site of spinal cord injury and real-time conditions of bladder and urethral function was assessed in order to provide a reasonable basis for the clinical treatment of neurogenic bladder. A total of 134 patients with spinal cord injuries (105 males, 29 females; averaged 34.1 years old) were involved in this retrospective analysis, including urodynamic evaluation, clinical examination and imaging for anatomical position, and Bors-Comarr classification. The associations between the levels of injury and urodynamic findings were analyzed. The results showed that mean follow-up duration was 16.7 months (range 8-27 months). Complete spinal cord injuries occurred in 21 cases, and incomplete spinal cord injuries in 113 cases. Of the 43 patients with upper motor neuron (UMN) injuries, hyperreflexia and (or) detrusor sphincter dyssynergia were demonstrated in 30 (69.8%), 31 (72.1%) suffered low bladder compliance (less than 12.5 mL/cmH(2)O), 28 (65.1%) had high detrusor leak point pressures (greater than 40 cmH(2)O), and 34 (79.1%) had residual urine. Of the 91 patients with lower motor neuron (LMN) injuries, areflexia occurred in 78 (85.7%), high compliance in 75 (82.4%), low leak point pressures in 80 (87.9%), and residual urine in 87 (95.6%), respectively. The associations between the anatomical site of spinal cord injury and urodynamic findings were ill defined. In patients with spinal cord injury, this study revealed a significant association between the level of injury and the type of voiding dysfunction. The anatomical site of spinal cord injury can not be predicted in real-time condition of bladder and urethral function. Management of neurogenic bladder in patients with spinal cord injury must be based on urodynamic findings rather than inferences from the neurologic evaluation.
评估脊髓损伤的解剖部位与膀胱和尿道功能实时状况之间的相关性，以便为神经源性膀胱的临床治疗提供合理依据。本回顾性分析共纳入134例脊髓损伤患者（男105例，女29例；平均年龄34.1岁），包括尿动力学评估、临床检查、解剖位置影像学检查以及Bors-Comarr分类。分析损伤水平与尿动力学结果之间的关联。结果显示，平均随访时间为16.7个月（范围8 - 27个月）。完全性脊髓损伤21例，不完全性脊髓损伤113例。在43例上运动神经元（UMN）损伤患者中，30例（69.8%）出现反射亢进和（或）逼尿肌括约肌协同失调，31例（72.1%）膀胱顺应性低（小于12.5 mL/cmH₂O），28例（65.1%）逼尿肌漏尿点压力高（大于40 cmH₂O），34例（79.1%）有残余尿。在91例下运动神经元（LMN）损伤患者中，78例（85.7%）出现无反射，75例（82.4%）顺应性高，80例（87.9%）漏尿点压力低，87例（95.6%）有残余尿。脊髓损伤的解剖部位与尿动力学结果之间的关联不明确。在脊髓损伤患者中，本研究揭示了损伤水平与排尿功能障碍类型之间存在显著关联。无法根据膀胱和尿道功能的实时状况预测脊髓损伤的解剖部位。脊髓损伤患者神经源性膀胱的管理必须基于尿动力学结果，而非神经学评估的推断。
