Bladder recovery in patients with traumatic cervical cord injury evaluated by voiding synchronous...

Voiding synchronous cystosphincterometry with uroflowmetry was used in 16 patients with traumatic cervical cord injury to evaluate bladder recovery. This method was shown to be reliable since the statistical analysis of the voiding responses showed the same values with repeated tests. A total of 14 patients with such injuries recovered from shock in 6 weeks and 10 acquired mature bladder contraction with a synergic external sphincteric urethra approximately 13 weeks after spinal cord injury. Bladders in patients with cervical cord injury usually recover from a state of inactive detrusor to that of a mature contraction by way of immature small and/or sustained contractions. Pressure measurements revealed 7.1 plus or minus 3.7 cm. water in the empty bladder and 74 plus or minus 20.5 cm. water (43 plus or minus 13.3 seconds in duration) in the recovered bladder contraction. Resting pressure in the external sphincteric urethra was 70 plus or minus 25.3 cm. water. The dyssynergic sphincter coexists with immature sustained bladder contraction and it usually improves to the synergic state, according to the degree of maturity of bladder contraction. The bladder and external urethral sphincter recover independently and a synergic response develops even in cases of complete lesions. Thus, synergy can be accomplished by regulatory mechanisms at the sacral cord level. Surgical intervention should be postponed if the maturity of bladder contraction is not yet established. More precise objective information in the dyssynergic bladder caused by cervical cord injury can be obtained when voiding synchronous cystosphincterometry with uroflowmetry is used.