Watanabe T, Vaccaro A R, Kumon H, Welch W C, Rivas D A, Chancellor M B
Division of Urologic Surgery, University of Pittsburgh, Pennsylvania, USA.
J Urol. 1998 Mar;159(3):965-8.
We determine the relationship between lower urinary tract function and somatic neurological status after thoracolumbar fracture.
Within 72 hours of thoracolumbar vertebral fracture we evaluated 44 consecutive patients, including 30 men and 14 women 17 to 84 years old (mean age 38.7), with occult neurogenic bladder dysfunction following incomplete thoracolumbar spinal injuries (American Spinal Injury Association impairment classifications C to E). The neurological level and degree of injury were established, and testing for perianal pinprick sensation and bulbocavernosus reflex was done. Video urodynamic evaluation was then performed between 3 and 14 days after injury but before spinal surgery.
Urodynamics revealed neurogenic lower urinary tract dysfunction in all 10 patients with classification C, 82% with D and 41% with E (otherwise completely intact neurologically) impairment. Although pinprick sensation deficiency and decreased bulbocavernosus reflex correlated with injury classification, lower urinary tract dysfunction was present in 62% of the patients with intact pinprick sensation and in 59% with intact bulbocavernosus reflex.
Neurologically intact patients with thoracolumbar spinal injuries may have neurogenic lower urinary tract dysfunction on urodynamics. Pinprick sensation and bulbocavernosus reflex are specific but not sensitive indicators of lower urinary tract dysfunction after spinal cord injury. Although these indicators, which demonstrate somatic nerve function, were absent in all patients with detrusor areflexia, intact pinprick sensation and bulbocavernosus reflex are not sensitive for predicting lower urinary tract function, which depends on autonomic nerve function. Urodynamic evaluation is mandatory for the complete evaluation of patients with incomplete lumbosacral spinal injuries.
我们确定胸腰椎骨折后下尿路功能与躯体神经状态之间的关系。
在胸腰椎骨折72小时内，我们评估了44例连续患者，包括30例男性和14例女性，年龄在17至84岁之间（平均年龄38.7岁），这些患者在胸腰椎不完全性脊髓损伤后存在隐匿性神经源性膀胱功能障碍（美国脊髓损伤协会损伤分级C至E级）。确定神经损伤平面和损伤程度，并进行肛周针刺觉和球海绵体反射检查。然后在受伤后3至14天但在脊柱手术前进行视频尿动力学评估。
尿动力学检查显示，所有10例C级损伤患者、82%的D级损伤患者和41%的E级损伤患者（其他方面神经功能完全正常）存在神经源性下尿路功能障碍。尽管针刺觉缺失和球海绵体反射减弱与损伤分级相关，但62%针刺觉正常的患者和59%球海绵体反射正常的患者存在下尿路功能障碍。
胸腰椎脊髓损伤神经功能正常的患者尿动力学检查可能存在神经源性下尿路功能障碍。针刺觉和球海绵体反射是脊髓损伤后下尿路功能障碍的特异性但非敏感指标。尽管所有逼尿肌无反射患者均无这些显示躯体神经功能的指标，但针刺觉正常和球海绵体反射正常对预测依赖自主神经功能的下尿路功能并不敏感。对于不完全性腰骶部脊髓损伤患者的全面评估，尿动力学评估是必需的。
