[Postoperative vesicourethral neurogenic dysfunction: the conceptual and clinical aspects based on the analysis of a series of 152 patients].
OBJECTIVE
To analyze the terminological and conceptual aspects of post-surgical vesicourethral neurogenic dysfunction, as well as the etiological, clinical and urodynamic data.


METHODS
We conducted a clinical and urodynamic study on 152 patients, 103 males (67.8%) and 49 females (32.2%), mean age 52.04 years, who presented with neurogenic bladder dysfunction after surgery or exploratory maneuvers. The preoperative urodynamic study was available in 123 cases (80.9%). The study protocol included patient clinical history, neurological physical examination to determine the level of the lesion and a complete urodynamic study (Wiest 8000), including selective sphincteric electromyography.


RESULTS
The study group comprised 59 patients (38.8%) who had undergone a neurosurgical procedure (25 patients had a disc hernia), 45 (29.6%) had undergone digestive surgery (abdominoperineal resection of the rectum was performed in 37 patients), 24 (15.7%) had undergone surgery for trauma (11 patients had a vertebral fracture), 12 (7.8%) had a urological procedure, 4 (2.6%) were referred from Gynecology and Obstetrics, 4 (2.6%) had received anesthesia or had undergone neurological explorations, 3 (1.9%) had undergone vascular surgery and 1 patient (0.6%) had received radiotherapy. The neurological lesions were supramesencephalic in 4 patients (2.6%), cervical in 14 (9.2%), dorsal in 6 (3.9%), lumbar in 6 (3.9%), conus medullaris in 17 (11.1%), cauda equina in 44 (28.9%) and peripheral in 61 (40.1%). Urinary incontinence (55 patients, 36.1%) was the most frequent cause for consultation. Other symptoms were difficulty in voiding (45 patients, 29.6%) acute urinary retention (33 patients, 21.7%), involvement of urge to void (33 patients, 8.5%) and daytime and/or nighttime frequency (6 patients, 3.9%). Acute urinary retention was statistically significant in the males (p < 0.05) and urinary incontinence in the females (p < 0.01). Incontinence was the most common symptom in patients submitted to radical prostatectomy. The correlation between conus medullaris lesion and acute urinary incontinence was significant (p < 0.001). Patients had referred symptoms for a mean of 8.5 +/- 30.7 months. Bladder reflex on cystomanometry was absent in 100 patients (65.8%) and present in 52 (34.2%). Thirty (57.6%) had voluntary and 22 (42.3%) had involuntary reflex (hyperreflexia). On electromyographic evaluation, baseline activity was normal in 84 patients (65.2%), diminished in 34 (26.3%) and absent in 11 (8.5%). The types of potentials were: normal in 35 cases (28.6%), positive waves 16 (13.1%), fibrillation in 24 (19.6%), polyphasic in 38 (31.1%), potentials with increased duration and/or amplitude in 8 cases (6.5%) and repetitive discharges in 1 case (0.8%). The following types of neurogenic vesicourethral dysfunctions were found: neurogenic shock in 10 patients (6.5%), lower motor neuron dysfunction in 109 (71.7%), upper motor neuron dysfunction in 22 (14.4%) and mixed motor neuron dysfunction in 11 (7.2%).


CONCLUSIONS
The term 'postsurgical vesicourethral neurogenic dysfunction' overcomes the limitations of previous terminology (e.g., iatrogenic neurogenic bladder) since it refers to the neurogenic dysfunction that presents after surgery regardless of the previous study. It is possible to obtain a clinical and urodynamic map of this condition whose etiology can be found fundamentally in disc hernia surgery (neurosurgery) and abdomino-perineal resection of the rectum (digestive surgery).
Esteban Fuertes
M
M
Unidad de Urodinámica, Hospital Universitario Príncipe de Asturias, Universidad de Alcalá de Henares, Madrid, España.
Salinas Casado
J
J
Resel Estévez
L
L
Sánchez Chapado
M
M
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D004576:Electromyography; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008365:Manometry; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology*; D012212:Rheology; D009626:Terminology as Topic; D014522:Urethral Diseases / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology*; D001750:Urinary Bladder, Neurogenic / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology*; D014563:Urodynamics