Division of Surgery and Interventional Science, University College London, London, WC1E 6BT.
London Spinal Cord Injury Centre, Royal National Orthopaedic Hospital, Stanmore, UK.
Neurourol Urodyn. 2021 Jan;40(1):219-227. doi: 10.1002/nau.24537. Epub 2020 Oct 26.
Transverse myelitis (TM) is an inflammation of the spinal cord which causes neurological deficit in motor, sensory, and autonomic pathways. Persistent neurogenic lower urinary tract dysfunction (NLUTD) is common even where motor and sensory impairment is recovered. Long term follow-up is required to ensure optimal bladder management and protection of the upper tracts. We describe the clinical outcomes for a cohort of patients with TM who have received neurourological follow-up in a specialist center.
A retrospective review of TM patient records was performed. Current pharmaceutical and surgical management, upper tract status, and patient reported symptoms are reported. Changes in urodynamic parameters and bladder emptying technique between current and baseline were analyzed.
Sixty patients with NLUTD following TM were identified. The mean age at onset of NLUTD was 29 years (0-77 years). The mean follow-up was 13 years. 55% of patients were taking antimuscarinic medication, 53% of patients had intradetrusor botulinum toxin injections and 5% had bladder augmentation surgery. Forty-one patients had a baseline and recent urodynamic study which could be compared. Fifty-three of fifty-eight patients with a recent renal ultrasound had normal renal appearance. Four had mild hydronephrosis and one more extensive hydronephrosis.
TM can have a persistent effect on lower urinary tract function. There is potential for upper tract damage if bladder management is not optimized. We have demonstrated that in a specialist neurourology unit within a tertiary center, one can provide acceptable long term outcomes following international guidelines.
横贯性脊髓炎（TM）是一种脊髓炎症，可导致运动、感觉和自主神经通路的神经功能缺损。即使运动和感觉功能恢复，持续性神经原性下尿路功能障碍（NLUTD）也很常见。需要进行长期随访，以确保最佳的膀胱管理和对上尿路的保护。我们描述了在专科中心接受神经泌尿科随访的 TM 患者队列的临床结果。
对 TM 患者的病历进行了回顾性审查。报告了当前的药物和手术治疗、上尿路状况以及患者报告的症状。分析了当前和基线之间尿动力学参数和膀胱排空技术的变化。
确定了 60 例 NLUTD 后的 TM 患者。NLUTD 的平均发病年龄为 29 岁（0-77 岁）。平均随访时间为 13 年。55%的患者服用抗毒蕈碱药物，53%的患者接受了逼尿肌内肉毒毒素注射，5%的患者接受了膀胱扩大手术。41 例患者有基线和近期尿动力学研究可供比较。58 例近期肾超声检查中有 53 例肾脏外观正常。4 例有轻度肾积水，1 例更广泛的肾积水。
TM 可能对下尿路功能产生持久影响。如果不优化膀胱管理，可能会对上尿路造成损害。我们已经证明，在三级中心的专科神经泌尿科，根据国际指南，我们可以提供可接受的长期结果。
