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Bladder and sphincter behavior in patients with spinal cord lesions
S A Kaplan1, M B Chancellor, J G Blaivas
1Department of Urology, College of Physicians and Surgeons, Columbia-Presbyterian Medical Center, New York, New York.
The Journal of Urology
|July 1, 1991
Summary
Clinical neurological level alone is insufficient for predicting bladder and sphincter dysfunction after spinal cord injury. Video-urodynamic studies offer a more precise diagnosis for vesicourethral function in these patients.
Area of Science:
- Neuroscience
- Urology
- Rehabilitation Medicine
Background:
- Spinal cord lesions can significantly impact bladder and sphincter function.
- Predicting vesicourethral dysfunction based solely on clinical neurological level has limitations.
Purpose of the Study:
- To investigate the relationship between clinical neurological level and bladder/sphincter behavior.
- To determine the diagnostic accuracy of clinical examination versus video-urodynamics for neurourological dysfunction.
Main Methods:
- Retrospective analysis of video-urodynamic studies in 489 patients with spinal cord lesions.
- Classification of patients by neurological level, lesion etiology, and sacral cord involvement.
- Categorization of urodynamic findings into detrusor hyperreflexia, detrusor-external sphincter dyssynergia, detrusor areflexia, or normal function.
Main Results:
- A general correlation exists between neurological level and vesicourethral function, but it's not absolute or specific.
- Detrusor areflexia was observed in cervical lesions, and dyssynergia in lumbar lesions.
- Positive predictive values for sacral cord signs with detrusor areflexia were 87%, and for negative signs with hyperreflexia/dyssynergia were 81%.
Conclusions:
- Clinical neurological examination alone is inadequate for predicting neurourological dysfunction.
- Video-urodynamic evaluation provides a more precise diagnosis of bladder and sphincter dysfunction in spinal cord injury patients.