Effect of spinal cord ischemia on vesicourethral function

Area of Science:

• Neurology
• Urology
• Neuroscience

Background:

• Spinal cord ischemia or infarction can lead to significant neurological deficits, including altered vesicourethral function.
• Understanding the specific pathways involved in bladder control after spinal cord injury is crucial for diagnosis and management.

Purpose of the Study:

• To investigate the relationship between spinal cord ischemia/infarction and vesicourethral dysfunction.
• To differentiate the sensory pathways responsible for bladder distention sensation and the urge to void.

Main Methods:

• Clinical evaluation of 9 patients with spinal cord ischemia/infarction and altered bladder function.
• Assessment of lower extremity and bladder sensation, including pinprick, light touch, and position sense.
• Electromyography (EMG) of the perineal muscles and response to bethanechol administration were used to evaluate detrusor muscle function.

Main Results:

• Six patients presented with anterior spinal artery syndrome, showing some preservation of bladder/lower extremity sensation.
• Three patients exhibited complete transverse myelopathy with no preserved sensation.
• Detrusor areflexia was observed in 6 patients, indicating longitudinal spinal cord involvement, while 3 had detrusor hyperreflexia with vesicosphincter dyssynergia.
• Dissociated bladder sensation (perception of distention without urge to void) occurred in 4 patients, suggesting distinct sensory pathways.

Conclusions:

• Bladder distention sensation is likely mediated by the posterior spinal cord.
• The sense of urgency to void is probably conveyed by the anterior spinal cord.
• These findings highlight the differential impact of spinal cord lesions on specific bladder functions.