Department of Physical Medicine and Rehabilitation, Hospital Raymond-Poincaré AP-HP, Garches, France.
Medical School Paris Île-de-France Ouest, Inserm U1179, Versailles Saint-Quentin University, Versailles, France.
World J Urol. 2022 Jul;40(7):1743-1749. doi: 10.1007/s00345-022-04044-w. Epub 2022 Jun 1.
Several patterns of urological dysfunctions have been described following spinal cord injury (SCI), depending on the level and the completeness of the injury. A better understanding of the natural history of neurogenic bladder in patients with SCI, and the description of their successive therapeutic lines based on their clinical and urodynamic pattern is needed to improve their management. This study aimed to describe the real-life successive therapeutic lines in patients with neurogenic lower urinary tract dysfunction (NLUTD) following SCI.
We conducted a two-center retrospective review of medical files of patients with SCI followed in two French specialized departments of Physical Medicine and Rehabilitation between January 2000 and January 2018. All patients with SCI with a level of lesion bellow T3 and older than 18 years old were eligible. The primary outcome was the description of the natural journey of neurogenic bladder in this population, from the awakening bladder contraction to the last therapeutic line. Survival curves were calculated with a 95-confidence interval using the Kaplan-Meier method.
One hundred and five patients were included in this study. Most of the patients were young men with a complete SCI lesion. The median time of treatment introduction was 1 and 9 years for anticholinergics and intradetrusor injection of BoNT/A, respectively. Median duration of effect of treatments was 4 and 6 years post-introduction of anticholinergics and BoNT/A, respectively.
This study describes NLUTD journey of patients with SCI demonstrating the mid-term efficacy of the two first therapeutic lines of NDO management. An improvement of non-surgical therapeutics is needed.
脊髓损伤（SCI）后会出现多种泌尿系统功能障碍模式，这取决于损伤的水平和完全性。为了改善管理，我们需要更好地了解 SCI 患者神经源性膀胱的自然病史，以及根据其临床和尿动力学模式描述其连续的治疗方案。本研究旨在描述 SCI 后伴有神经源性下尿路功能障碍（NLUTD）患者的实际连续治疗方案。
我们对 2000 年 1 月至 2018 年 1 月在法国两个物理医学与康复专科中心随访的 SCI 患者的医疗档案进行了两项中心的回顾性研究。所有符合条件的患者均为 T3 以下水平损伤且年龄大于 18 岁的 SCI 患者。主要结局是描述该人群中神经源性膀胱的自然病程，从觉醒性膀胱收缩到最后一种治疗方案。使用 Kaplan-Meier 法计算 95%置信区间的生存曲线。
本研究共纳入 105 例患者。大多数患者为年轻男性，存在完全性 SCI 损伤。抗胆碱能药物和肉毒毒素 A 膀胱内注射的中位治疗引入时间分别为 1 年和 9 年。抗胆碱能药物和肉毒毒素 A 引入后的治疗效果中位持续时间分别为 4 年和 6 年。
本研究描述了 SCI 患者的 NLUTD 病程，证明了 NDO 管理的前两种治疗方案的中期疗效。需要改善非手术治疗。
