Department of Urology and Andrology, University of Perugia, Ospedale Santa Maria della Misericordia, Perugia, Italy.
Arch Phys Med Rehabil. 2011 Jul;92(7):1134-8. doi: 10.1016/j.apmr.2011.02.013.
To investigate voiding dysfunction and upper urinary tract status in survivors of coma resulting from traumatic brain injury (TBI), and to compare clinical and urodynamic results with neurologic and psychological features as well as functional outcomes.
Observational study focused on urologic dysfunction and neurologic outcome in coma survivors after traumatic brain injury in the postacute and chronic phase.
A postcoma unit in a rehabilitation hospital.
Consecutive patients (N=57) who recovered from coma of traumatic etiology and who were admitted during a 1-year period to a postcoma unit of a rehabilitation hospital.
Patients underwent clinical urologic assessment, urodynamics with the assessment of the Schafer nomogram and the projected isovolumetric detrusor pressure to evaluate detrusor contractility, ultrasound assessment of the lower and upper urinary tract and voiding cystourethrography, routinely performed, according to the International Continence Society Standards. Neurologic variables assessed were brain injury and disability severity, and neuropsychological status. Neuroimaging identified the site of cerebral lesions.
Urinary symptoms, disability by means of the Glasgow Outcome Scale (GOS), and neuropsychological status by means of the Neurobehavioral Rating Scale (NBRS), and the relationships among them.
Of the 57 patients studied, 30 had overactive bladder (urge incontinence) symptoms, 28 had detrusor overactivity, and 18 had detrusor underactivity with associated pseudodyssynergia in 15 of these patients. Eleven patients had hypertrophic bladder; 3, bilateral pyelectasia; and 2, vesicoureteral reflux. Disability measured by GOS was severe in 8 patients and moderate in 27, while recovery was good in 22 patients. The mean NBRS total score indicated a mild cognitive impairment. Neuroimaging showed diffuse brain injury in all patients. Statistically significant relationships were found between urge incontinence, detrusor overactivity, and poor neurologic functional outcome, between detrusor overactivity and right hemisphere damage (P=.0001), and between impaired detrusor contractility and left hemisphere injuries (P=.0001).
Most patients who recovered from coma resulting from TBI have symptoms of overactive bladder syndrome and voiding difficulties. These urinary problems correlate with cerebral involvement and neurologic functional outcome.
研究创伤性脑损伤（TBI）所致昏迷幸存者的排尿功能障碍和上尿路状态，并将临床和尿动力学结果与神经学和心理学特征以及功能结果进行比较。
观察性研究侧重于创伤性脑损伤后昏迷幸存者的泌尿科功能障碍和神经学结局，处于亚急性期和慢性期。
康复医院的昏迷后病房。
连续患者（N=57），因创伤性病因从昏迷中恢复过来，并在康复医院的昏迷后病房接受治疗 1 年。
患者接受临床泌尿科评估、尿动力学检查，评估 Schafer 图表和预测等容逼尿肌压力，以评估逼尿肌收缩力，进行下尿路和上尿路的超声评估和排尿膀胱尿道造影术，根据国际尿控协会标准常规进行。评估的神经学变量包括脑损伤和残疾严重程度以及神经心理学状态。神经影像学确定了脑损伤部位。
尿症状、格拉斯哥结果量表（GOS）评估的残疾程度以及神经行为评定量表（NBRS）评估的神经心理学状态，以及它们之间的关系。
在 57 名研究患者中，30 名患有逼尿肌过度活动症（急迫性尿失禁）症状，28 名患有逼尿肌过度活动症，18 名患有逼尿肌活动不足，其中 15 名伴有假性协同失调。11 名患者患有肥厚性膀胱；3 名患者双侧肾盂扩张；2 名患者患有膀胱输尿管反流。根据 GOS 评估，8 名患者为重度残疾，27 名患者为中度残疾，22 名患者恢复良好。NBRS 总分平均表明存在轻度认知障碍。神经影像学显示所有患者均有弥漫性脑损伤。急迫性尿失禁、逼尿肌过度活动与不良神经功能结局之间存在显著相关性，逼尿肌过度活动与右半球损伤之间存在相关性（P=.0001），逼尿肌收缩力受损与左半球损伤之间存在相关性（P=.0001）。
大多数从 TBI 导致的昏迷中恢复的患者都有逼尿肌过度活动综合征和排尿困难的症状。这些泌尿系统问题与脑损伤和神经功能结局有关。
