Gupta Anupam, Taly Arun B, Srivastava Abhishek, Thyloth Murali
Department of Psychiatric and Neurological Rehabilitation, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, India.
Ann Indian Acad Neurol. 2009 Jan;12(1):35-9. doi: 10.4103/0972-2327.48850.
To study the significance of filling cystometry in assessment and management of neurogenic bladder in myelopathies and correlate neurological recovery and bladder management in the follow up.
Retrospective analysis of reports of filling cystometry in patients with traumatic and non-traumatic myelopathy.
Neuro-rehabilitation unit of a tertiary care university hospital.
The study was carried out between September 2005 and June 2006 and included all subjects with myelopathy who underwent filling cystometry. ASIA impairment scale was used to assess neurological status during admission as well as in the follow up. Bladder management was advised based on the cystometric findings. Neurological recovery and mode of bladder management were correlated during the follow up after a minimum of 6 months.
Fifty-two subjects (38 males, 14 females), mean age 33.26 +/- 14.66 years (10-80) underwent filling cystometry. Twenty patients had cervical, 24 had thoracic and 8 had lumbar myelopathy. Cystometric findings were overactive detrusor observed in 43 patients, (21 had detrusor sphincter dyssynergia (DSD), 22 without DSD) and areflexic/underactive detrusor in 9. Post-void residual (>15% of voided urine) was significant in 27 patients. Twenty-three patients (44%) reported for follow up (16 males, 7 females) after a mean duration of 9.04 +/- 2.44 months (6-15 months). Neurological recovery was seen in 61% cases, while 1 patient showed deterioration. Only 26% patients reported change in bladder management during follow up. Correlation between neurological recovery and bladder management was found to be insignificant (P > 0.05) using spearman correlation co-efficient.
Filling cystometry is valuable for assessment and management of neurogenic bladder after myelopathy. No significant relationship was observed between neurological recovery and neurogenic bladder management in the follow up in the present study.
研究充盈性膀胱测压在脊髓病所致神经源性膀胱评估及管理中的意义,并在随访中关联神经功能恢复情况与膀胱管理措施。
对创伤性和非创伤性脊髓病患者的充盈性膀胱测压报告进行回顾性分析。
一所三级护理大学医院的神经康复科。
研究于2005年9月至2006年6月进行,纳入所有接受充盈性膀胱测压的脊髓病患者。采用美国脊髓损伤协会(ASIA)损伤分级量表在入院时及随访时评估神经功能状态。根据膀胱测压结果给出膀胱管理建议。在至少6个月的随访期内,关联神经功能恢复情况与膀胱管理方式。
52例受试者(38例男性,14例女性),平均年龄33.26±14.66岁(10 - 80岁)接受了充盈性膀胱测压。20例为颈髓病变,24例为胸髓病变,8例为腰髓病变。膀胱测压结果显示,43例患者逼尿肌过度活动(其中21例伴有逼尿肌括约肌协同失调(DSD),22例无DSD),9例患者逼尿肌无反射/活动低下。27例患者排尿后残余尿量(>排尿量的15%)显著增加。23例患者(44%)在平均9.04±2.44个月(6 - 15个月)后进行了随访(16例男性,7例女性)。61%的病例神经功能有恢复,1例患者病情恶化。随访期间仅26%的患者报告膀胱管理措施有改变。采用Spearman相关系数分析发现,神经功能恢复与膀胱管理之间无显著相关性(P>0.05)。
充盈性膀胱测压对脊髓病后神经源性膀胱的评估及管理具有重要价值。在本研究的随访中,未观察到神经功能恢复与神经源性膀胱管理之间存在显著关联。