Damphousse M, Hubeaux K, Weil M, Raibaut P, Lebreton F, Amarenco G
Service de rééducation neurologique et d'explorations périnéales, hôpital Rothschild, groupe hospitalier universitaire Est, AP-HP, 33, boulevard de picpus, 75012 Paris, France.
Prog Urol. 2010 Jun;20(6):450-7. doi: 10.1016/j.purol.2010.01.002. Epub 2010 Feb 9.
The bladder deformations observed in the neurogenic bladders are frequent, particularly in the "upper motor neuron" bladder type (paraplegia, multiple sclerosis). We wanted to verify the predictive factors of such damage and particularly, if the urodynamic typology intervened in their genesis by using the model of cauda equina syndrome and conus medullaris lesions.
We have studied retrospectively the presence of cystographic bladder deformations at patients with neurogenic bladder due to cauda equina syndrome or conus medullaris lesion according to their urodynamic status: either overactive or acontractile detrusor.
Of 68 patients, (mean age 47.2 years), 34 had an overactive and 34 an acontractile detrusor. The presence of bladder deformations was associated with an overactive detrusor (p=0.04). However, 50% of the patients with acontractile detrusor had bladder deformations, and those deformations were associated with male sex, and this excluding urologic obstruction.
This study demonstrates the existence of bladder deformations in the hypoactive lower motor neuron neurogenic bladder type. If the bladder deformations seem more frequent in the overactive neurogenic bladder type, their specific and repeated search is also necessary during the follow-up of the lower motor neuron neurogenic bladder type.
神经源性膀胱中观察到的膀胱变形很常见，尤其是在“上运动神经元”膀胱类型（截瘫、多发性硬化症）中。我们想通过使用马尾综合征和脊髓圆锥损伤模型来验证此类损伤的预测因素，特别是尿动力学类型是否在其发生过程中起作用。
我们根据尿动力学状态（逼尿肌过度活跃或无收缩力），回顾性研究了因马尾综合征或脊髓圆锥损伤导致神经源性膀胱的患者膀胱造影时膀胱变形的情况。
68例患者（平均年龄47.2岁）中，34例逼尿肌过度活跃，34例逼尿肌无收缩力。膀胱变形的存在与逼尿肌过度活跃有关（p = 0.04）。然而，50%逼尿肌无收缩力的患者有膀胱变形，且这些变形与男性相关，排除泌尿系统梗阻情况。
本研究证明了下运动神经元神经源性膀胱类型中存在膀胱变形。如果膀胱变形在逼尿肌过度活跃的神经源性膀胱类型中似乎更常见，那么在随访下运动神经元神经源性膀胱类型时，也有必要进行针对性和反复的检查。
