Gliga Louise A, Lavelle Rebecca S, Christie Alana L, Coskun Burhan, Greenberg Benjamin M, Carmel Maude E, Lemack Gary E
Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas.
Neurourol Urodyn. 2017 Feb;36(2):360-363. doi: 10.1002/nau.22930. Epub 2015 Nov 20.
To characterize urodynamic findings in patients referred with transverse myelitis (TM) and lower urinary tract symptoms (LUTS), as well as to identify any characteristics predictive of urodynamics findings.
This is a retrospective review of an IRB-approved neurogenic bladder database of patients followed by a single surgeon between 2001 and 2013. Patient characteristics, questionnaire data, radiologic studies, and urodynamic parameters were analyzed.
Of the 836 patients in the neurogenic bladder database, 28 patients (17 females, 11 males) were referred with a principle diagnosis of TM (3%). Twenty-one of twenty-eight patients (75%) underwent urodynamics testing. Bladder management at initial urologic evaluation was CIC or urethral catheter for 16/28 patients (57.1%). Median MCC was 303 ml (85-840 ml), detrusor overactivity (DO) was present in 16/21 (76%), detrusor sphincter dyssynergia (DSD) in 10/21 (48%), and decreased compliance in 7/21 (33%). For those voiding, mean Qmax was 12 ± 10 ml/sec and pdet at Qmax was 41 ± 17 cmH O. Longitudinally extensive TM (LETM) was the only patient characteristic associated with DO (P = 0.0276). No other patient characteristics were associated with urodynamics parameters.
Significant urodynamic testing abnormalities are noted in the majority of TM patients undergoing urodynamics, with 95% having DO, DSD, altered compliance, or detrusor underactivity. Other than the association between LETM and DO, there were no patient characteristics predictive of urodynamics findings. Based on the severity of urodynamics findings in our series, patients with TM and LUTS should have thorough baseline urological evaluations including urodynamics and be offered ongoing surveillance. Neurourol. Urodynam. 36:360-363, 2017. © 2015 Wiley Periodicals, Inc.
描述患有横贯性脊髓炎（TM）和下尿路症状（LUTS）患者的尿动力学检查结果，并确定任何可预测尿动力学检查结果的特征。
这是一项对经机构审查委员会批准的神经源性膀胱数据库的回顾性研究，该数据库涵盖了2001年至2013年间由一位外科医生随访的患者。分析了患者特征、问卷数据、放射学研究和尿动力学参数。
在神经源性膀胱数据库的836例患者中，28例（17例女性，11例男性）以TM作为主要诊断被转诊（3%）。28例患者中有21例（75%）接受了尿动力学检查。在初次泌尿外科评估时，16/28例患者（57.1%）的膀胱管理方式为间歇性导尿或留置尿道导管。中位膀胱容量为303ml（85 - 840ml），16/21例（76%）存在逼尿肌过度活动（DO），10/21例（48%）存在逼尿肌括约肌协同失调（DSD），7/21例（33%）存在顺应性降低。对于那些能够排尿的患者，平均最大尿流率为12±10ml/秒，最大尿流率时的膀胱内压为41±17cmH₂O。纵向广泛横贯性脊髓炎（LETM）是唯一与DO相关的患者特征（P = 0.0276）。没有其他患者特征与尿动力学参数相关。
在大多数接受尿动力学检查的TM患者中发现了显著的尿动力学检查异常，95%的患者存在DO、DSD、顺应性改变或逼尿肌活动低下。除了LETM与DO之间的关联外，没有患者特征可预测尿动力学检查结果。基于我们系列研究中尿动力学检查结果的严重程度，患有TM和LUTS的患者应进行包括尿动力学检查在内的全面基线泌尿外科评估，并接受持续监测。《神经泌尿学与尿动力学》36:360 - 363，2017。©2015威利期刊公司。
