Predicting lower urinary tract dysfunctions in patients with spinal cord injury.

The results of combined cystometry and perineal electromyography were reviewed retrospectively in 75 consecutive, traumatic spinal cord-injured patients to predict lower urinary tract dysfunctions. In patients with vertebral spinal injuries at vertebral level T7 or above a reflex neurogenic bladder eventually developed. In those with vertebral level injuries T11 or below a lower motor neuron bladder dysfunction developed. Injuries at the vertebral levels T8, T9, and T10 represent a gray zone; and, depending on adjacent soft tissue injury, in these patients an upper or lower motor neuron bladder dysfunction developed. In transition from spinal shock (areflexia) to reflex neurogenic (hyperreflexia) bladder occurred at different times in different patients and could not be correlated to level of injury or its severity. The periurethral striated muscle was generally denervated if a lower motor neuron bladder dysfunction existed, however, rarely, dissociation may occur. When a reflex neurogenic bladder existed, sphincter dyssynergia was present 68 per cent of the time. This also could not be correlated with time after injury, level of injury, or severity of injury.