Lim Victor, Mac-Thiong Jean-Marc, Dionne Antoine, Begin Jean, Richard-Denis Andréane
Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada.
Department of Orthopedic Surgery, Hôpital du Sacré-Coeur de Montréal, CIUSSS du Nord-de-l'Île-de-Montréal, Montreal, Quebec, Canada.
J Neurotrauma. 2021 Mar 15;38(6):718-724. doi: 10.1089/neu.2020.7190. Epub 2020 Dec 3.
Bladder dysfunction is widespread following traumatic spinal cord injury (TSCI). Early diagnosis of bladder dysfunction is crucial in preventing complications, determining prognosis, and planning rehabilitation. We aim to suggest the first clinical protocol specifically designed to evaluate and manage bladder dysfunction in TSCI patients during acute care. A retrospective cohort study was conducted on 101 patients admitted for an acute TSCI between C1 and T12. Following spinal surgery, presence of voluntary anal contraction (VAC) was used as a criterion for removal of indwelling catheter and initiating trial of void (TOV). Absence of bladder dysfunction was determined from three consecutive post-void bladder scan residuals ≤200 mL without incontinence. All patients were reassessed 3 months post-injury using the Spinal Cord Independence Measure (SCIM). A total of 74.3% were diagnosed with bladder dysfunction during acute care, while 57.4% had a motor-complete TSCI. Three months later, 94.7% of them reported impaired bladder function. None of the patients discharged from acute care after a functional bladder was diagnosed reported impaired bladder function at the 3-month follow-up. A total of 95.7% patients without VAC had persisting impaired bladder function at follow-up. The proposed protocol is specifically adapted to the dynamic nature of neurogenic bladder function following TSCI. The assessment of VAC into the protocol provides major insight on the potential for reaching adequate bladder function during the subacute phase. Conducting TOV using bladder scan residuals in patients with VAC is a non-invasive and easy method to discriminate between a functional and an impaired bladder following acute TSCI.
创伤性脊髓损伤（TSCI）后膀胱功能障碍很常见。膀胱功能障碍的早期诊断对于预防并发症、确定预后和规划康复至关重要。我们旨在提出首个专门设计用于评估和管理急性护理期间TSCI患者膀胱功能障碍的临床方案。对101例C1至T12急性TSCI入院患者进行了回顾性队列研究。脊柱手术后，将自主肛门收缩（VAC）的存在作为拔除留置导尿管和开始排尿试验（TOV）的标准。连续三次排尿后膀胱扫描残余尿量≤200 mL且无尿失禁则确定无膀胱功能障碍。所有患者在受伤后3个月使用脊髓独立测量量表（SCIM）进行重新评估。共有74.3%的患者在急性护理期间被诊断为膀胱功能障碍，而57.4%的患者为运动完全性TSCI。三个月后，其中94.7%的患者报告膀胱功能受损。在诊断出功能性膀胱后从急性护理出院的患者中，没有一例在3个月随访时报告膀胱功能受损。共有95.7%没有VAC的患者在随访时持续存在膀胱功能受损。所提出的方案特别适用于TSCI后神经源性膀胱功能的动态特性。将VAC评估纳入方案可对亚急性期达到足够膀胱功能的可能性提供重要见解。对有VAC的患者使用膀胱扫描残余尿量进行TOV是一种非侵入性且简便的方法，可用于区分急性TSCI后功能性膀胱和受损膀胱。
