Sakakibara R, Hattori T, Yasuda K, Yamanishi T
Department of Neurology, Kashima Rosai Hospital, Japan.
Spinal Cord. 1996 Aug;34(8):481-5. doi: 10.1038/sc.1996.82.
In ten patients with acute transverse myelitis (ATM), seven patients had urinary retention, and the other three patients had difficulty in voiding within 1 month from the onset of the disease. Five of the patients with retention became able to urinate. After the mean follow-up period of 40 months, nine still had urinary symptoms including difficulty in voiding in five and urinary frequency, urgency and incontinence in four patients. Four patients had urinary disturbance as the sole sequel of ATM. Urodynamic studies performed on nine patients revealed that all of the three patients with the urgent incontinence had detrusor hyperreflexia, all of the four patients with retention had an areflexic cystometrogram as well as sphincter hyperreflexia, and three of five patients with voiding difficulty had detrusor-sphincter dyssynergia. An areflexic cystometrogram tended to change to a low compliance bladder, followed by detrusor hyperreflexia or a normal cystometrogram. Analysis of the motor unit potentials of the external sphincter revealed that two of the three patients had high amplitude or polyphasic neurogenic changes. Supranuclear as well as nuclear types of parasympathetic and somatic nerve dysfunctions seemed to be responsible for micturition disturbance in our patients with ATM.
在10例急性横贯性脊髓炎（ATM）患者中，7例出现尿潴留，另外3例在发病1个月内排尿困难。其中5例尿潴留患者后来能够自行排尿。平均随访40个月后，9例仍有泌尿系统症状，包括5例排尿困难，4例尿频、尿急和尿失禁。4例患者的泌尿系统紊乱是ATM的唯一后遗症。对9例患者进行的尿动力学研究显示，3例急迫性尿失禁患者均出现逼尿肌反射亢进，4例尿潴留患者均有无反射性膀胱测压图以及括约肌反射亢进，5例排尿困难患者中有3例出现逼尿肌-括约肌协同失调。无反射性膀胱测压图往往会转变为低顺应性膀胱，随后出现逼尿肌反射亢进或正常膀胱测压图。对尿道外括约肌运动单位电位的分析显示，3例患者中有2例出现高波幅或多相性神经源性改变。我们的ATM患者排尿障碍似乎是由核上及核型副交感神经和躯体神经功能障碍引起的。
