Lu Junyan, Cheng Bo, Lin Le, Yue Shouwei
Rehabilitation Center, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China; Department of Physical Medicine & Rehabilitation, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
Department of Rehabilitation Medicine, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
Ann Palliat Med. 2021 Mar;10(3):3171-3178. doi: 10.21037/apm-21-314.
Urodynamics is the gold standard for evaluating the function of neurogenic bladder after spinal cord injury (SCI), but there are few studies on urodynamics in patients with complete and incomplete suprasacral SCI in different periods.There is a lack of sufficient evidence for the timing of the first urodynamic examination.
The urodynamic results of 101 patients with complete and incomplete suprasacral SCI at 0-30, 31-60, 61-90, and 91-365 days after injury were included. Urodynamic parameters were compared between 0-90 and 91-365 days, including detrusor overactivity (DO), bladder compliance (BC), bladder-filling sensation, maximum cystometric capacity (MCC), detrusor external sphincter dyssynergia (DESD), maximum urinary flow rate (Qmax), detrusor pressure at a maximum urinary flow rate (PdetQmax).
There were 45 patients with complete SCI and 56 with incomplete SCI. With the course's prolongation, the proportion of DO increased gradually in patients with complete and incomplete injury within 90 days, while the MCC gradually decreased. The bladder-filling sensation of patients with complete SCI is mostly absent. Significant differences were found between 0-90 and 91-365 days in terms of DO, DESD, MCC, Qmax, and PdetQmax incomplete SCI, and DESD in incomplete SCI, and between complete and incomplete SCI in terms of DO, bladder filling sensation, MCC, Qmax, PdetQmax at 0-90 days after injury, and bladder filling sensation at 91-365 days after injury.
Urodynamic examination should be conducted as soon as possible after injury in patients with incomplete suprasacral SCI, while for those with complete injury, the urodynamic examination can be initiated following clinical symptoms within 90 days after injury.
尿动力学检查是评估脊髓损伤(SCI)后神经源性膀胱功能的金标准,但关于不同时期完全性和不完全性骶上脊髓损伤患者尿动力学的研究较少。首次尿动力学检查的时机缺乏充分证据。
纳入101例骶上脊髓损伤完全性和不完全性患者在伤后0 - 30天、31 - 60天、61 - 90天和91 - 365天的尿动力学检查结果。比较0 - 90天和91 - 365天的尿动力学参数,包括逼尿肌过度活动(DO)、膀胱顺应性(BC)、膀胱充盈感觉、最大膀胱测压容量(MCC)、逼尿肌外括约肌协同失调(DESD)、最大尿流率(Qmax)、最大尿流率时的逼尿肌压力(PdetQmax)。
完全性脊髓损伤患者45例,不完全性脊髓损伤患者56例。随着病程延长,90天内完全性和不完全性损伤患者中DO比例逐渐增加,而MCC逐渐降低。完全性脊髓损伤患者大多无膀胱充盈感觉。在不完全性脊髓损伤中,0 - 90天和91 - 365天之间在DO、DESD、MCC、Qmax和PdetQmax方面存在显著差异,在不完全性脊髓损伤中DESD也有差异,在伤后0 - 90天,完全性和不完全性脊髓损伤在DO、膀胱充盈感觉、MCC、Qmax、PdetQmax方面存在差异,在伤后91 - 365天膀胱充盈感觉方面也存在差异。
不完全性骶上脊髓损伤患者伤后应尽早进行尿动力学检查,而对于完全性损伤患者,可在伤后90天内根据临床症状开始进行尿动力学检查。