Disturbances of micturition in patients with a spinal arteriovenous malformation.
Neuro-urological studies were performed on 9 patients with a spinal arteriovenous malformation (S-AVM). The micturitional history revealed that all 9 patients had voiding symptoms, obstructive in 9 and irritative in 3 patients. All patients still had obstructive symptoms after treatment of S-AVM. Six of the 9 patients had a large volume of residual urine before treatment; 5 showed urinary retention. Four of the 5 patients (80%) for whom urodynamic studies were performed before treatment had micturitional dysfunction; 2 patients had detrusor hyperreflexia, 1 with detrusor external urethral sphincter dyssynergia (DSD) and 1 with a normal sphincter, 1 patient had an autonomous bladder with DSD and 1 patient had an atonic bladder with DSD. Only 1 patient had a normal bladder and sphincter. Findings of the urodynamic studies after treatment in 9 patients showed detrusor hyperreflexia in 3 patients (2 with DSD and 1 with normal sphincter), autonomous bladder in 1 patient with DSD, atonic bladder in 4 patients (2 with DSD, 1 with incompetent sphincter and 1 with normal sphincter) and normal bladder with normal sphincter in 1 patient. Lower urinary function after treatment of S-AVM was improved in 2 patients, unchanged in 4 patients and worsened in 3 patients. The above results showed 80% of S-AVM had a severe neuropathic bladder manifested mainly by disturbance of micturition. Treatment of S-AVM does not necessarily improve the lower urinary tract function.
Department of Urology, School of Medicine, Chiba University, Japan.
N
N
Murayama
K
K
Yasuda
T
T
Yamanishi
T
T
Hattori
H
H
Kitahara
J
J
Shimazaki
D000328:Adult; D000368:Aged; D001165:Arteriovenous Malformations / Q000150:complications* / Q000503:physiopathology / Q000628:therapy; D004576:Electromyography; D005260:Female; D006801:Humans; D007866:Leg / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D013116:Spinal Cord / Q000098:blood supply*; D014521:Urethra / Q000503:physiopathology; D014554:Urination; D014555:Urination Disorders / Q000209:etiology* / Q000503:physiopathology; D014563:Urodynamics