[Urological findings in spinal cord ischemia]

Spinal cord ischemia is a circulatory disorder of acute or subacute establishment and neurological clinic of medullar section, usually incomplete. We describe clinical and anatomical characteristics, as well as diagnostic methods and therapeuthic used in these patients.

Since 1987 to 2007, 65 patients were diagnosed of spinal cord ischemia in our hospital. Clinical interview, neurological examination and image study were performed. Urodynamic study was performed after medullar shock phase, including cystometry, pressure flow study and external urinary sphincter electromyography. We have reviewed treatment applied in these patients.

65 patients (27 women and 38 men), median age 63 years (15-87). 28 patients (43%) presented high lesion (upper to T7), 32 (49%) middle (T7-L2) and 4 (6%) low lesion (below L2). Flaccid paraplegia and acute urinary retention were the most frequent clinical findings at the begining. Aetiology was determined mainly by Magnetic Resonance. Urodynamic study revealed: 9 patients (47.4%) with high spinal cord lesion and detrusor overactivity (with or without dyssynergia), and 6 (31.5%) with arreflexia; 11 patients (47.8%) with middle spinal cord lesion and detrusor overactivity and 7 patients with arreflexia (30.4%); one patient with low spinal cord lesion and detrusor overactivity, and another one with arreflexia (33%).

There is a good correlation among lesion level and clinical findings in traumatic spinal cord injuries, but this is not the same in spinal cord ischemia. Probably, incomplete and patched lesions in vascular spinal cord injuries could explain this lack of correlation. Therefore, it is mandatory to performe an exhaustive neurological and urological evaluation of these patients in order to select the best treatment and prevent upper urinary tract damage in the future.