Shahmohammadi Mohammadreza, Khoshuod Reza Jalil, Zali Alireza, Seddeghi Amir Saied, Kabir Nima Mohseni
Functional Neurosurgery Research Center, Shohada Tajrish Neurosurgical Center of Excellent, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Acta Inform Med. 2016 Oct;24(5):328-331. doi: 10.5455/aim.2016.24.328-331. Epub 2016 Nov 1.
Cauda equina syndrome is a rare disorder that causes loss of Lumbar plexus function (nerve roots) lower than conus medullaris. No risk factor has been defined for this disease yet. Due to the high morbidity of Cauda equina syndrome and lack of sufficient information about the connection between the disease and urodynamic findings and EMG (Electromyography) findings, the need for this comprehensive study is felt.
The aim is to determine the predictive power of findings resulted from urodynamics and electromyography of perineal region and around sphincter in the clinical cure rate of urination in patients with urinary retention followed by Cauda equina syndrome.
Patients referred to Shohadaye Tajrish Hospital during the years 2009 to 2013, in case of having Cauda equina syndrome symptoms (confirmed with Lumbar MRI), were undergone urodynamic examination and perineal electromyography after surgical decompression action. These both assessments (urodynamic study and electromyography) were repeated during the follow-up of 15 patients in the first and sixth months after surgery and findings were compared with each other.
Among the Urodynamic findings, Qmax (maximum urine flow) during three studies had a significant relationship with long-term recovery rate of patients (P <0.05). The relationship had been more valuable in follow-ups after one month (P = 0.0001). Also, BCI (Bladder Contractility Index) in all three studies had a significant relationship with clinical improvement in the ability to urinate (P <0.001). The residual urine (PVR) compared to two previous urodynamic findings showed a less significant relationship with clinical cure rate (P = 0.04). Among the findings of muscle-nerve (MUAP Fibrillation, Positive sharp way) none of them had a significant relationship with cure rate.
Urodynamic finding, especially Qmax and bladder contractility index, can be considered as predictive indicators for patients' recovery after surgery.
马尾综合征是一种罕见疾病，可导致脊髓圆锥以下的腰丛神经功能（神经根）丧失。目前尚未明确该疾病的危险因素。由于马尾综合征的高发病率以及关于该疾病与尿动力学检查结果和肌电图（EMG）检查结果之间联系的信息不足，因此感到有必要进行这项全面研究。
目的是确定会阴部及括约肌周围的尿动力学和肌电图检查结果对马尾综合征后尿潴留患者排尿临床治愈率的预测能力。
2009年至2013年期间转诊至塔吉什烈士医院的患者，若出现马尾综合征症状（经腰椎MRI证实），在手术减压后接受尿动力学检查和会阴部肌电图检查。在15例患者术后第1个月和第6个月的随访期间重复进行这两项评估（尿动力学研究和肌电图检查），并将结果相互比较。
在尿动力学检查结果中，三项研究中的最大尿流率（Qmax）与患者的长期恢复率有显著关系（P<0.05）。这种关系在术后1个月的随访中更有价值（P = 0.0001）。此外，三项研究中的膀胱收缩指数（BCI）与排尿能力的临床改善有显著关系（P<0.001）。与前两次尿动力学检查结果相比，残余尿量（PVR）与临床治愈率的关系不太显著（P = 0.04）。在肌肉-神经检查结果（运动单位动作电位纤颤、正锐波）中，没有一项与治愈率有显著关系。
尿动力学检查结果，尤其是最大尿流率和膀胱收缩指数，可被视为患者术后恢复的预测指标。
