Perkash I, Friedland G W
Radiology. 1986 May;159(2):453-5. doi: 10.1148/radiology.159.2.3515423.
In part 1 of this study, 77 consecutive patients with spinal cord injuries and reflex bladders were examined by combined urodynamic studies and sonographic voiding cystourethrography. Of the 15 (19%) who had hyperreflexic bladders (reflex bladders that contracted when containing 125 ml or less), eight (53%) had catheter-induced hyperreflexia (proved by sonographic voiding cystourethrography without catheterization). The significant overdiagnosis influenced patient care because catheter-induced hyperreflexia did not require treatment, whereas primary hyperreflexia caused by lesions above T-5 always required anticholinergic therapy to prevent potentially life-threatening autonomic dysreflexia. In part 2 of this study, 116 additional spinal cord injury patients with reflex bladders were studied, although in these patients the catheter was introduced under sonographic control. Seven (6%) of these patients had hyperreflexia, but in none was the hyperreflexia catheter induced, showing that use of sonography while introducing the catheter can prevent catheter-induced hyperreflexia.
在本研究的第一部分，对77例连续性脊髓损伤合并反射性膀胱患者进行了尿动力学检查及超声排尿膀胱尿道造影联合检查。在15例（19%）膀胱反射亢进（膀胱容量在125ml及以下时出现收缩的反射性膀胱）患者中，8例（53%）存在导尿管诱发的反射亢进（经无导尿管的超声排尿膀胱尿道造影证实）。这种显著的过度诊断影响了患者的治疗，因为导尿管诱发的反射亢进无需治疗，而T-5以上病变引起的原发性反射亢进总是需要抗胆碱能治疗以预防可能危及生命的自主神经反射异常。在本研究的第二部分，又对116例脊髓损伤合并反射性膀胱患者进行了研究，不过在这些患者中，导尿管是在超声引导下插入的。这些患者中有7例（6%）存在反射亢进，但均非导尿管诱发，这表明在插入导尿管时使用超声可预防导尿管诱发的反射亢进。
