title: Effect of the trauma mechanism on the bladder-sphincteric behavior after spinal cord injury.
abstract: METHODS
  Retrospective study.
  
  
  OBJECTIVE
  To determine if spinal cord injuries due to gunshot wounds (GW) are associated with different bladder and sphincteric behavior compared to other trauma mechanisms.
  
  
  METHODS
  Spinal injury center, Brazilian university hospital.
  
  
  METHODS
  We retrospectively evaluated the records and urodynamic studies of 71 patients with spinal cord injury (SCI) referred to the Brazilian National Spinal Cord Injury Center over the year 2000, and compared the bladder-sphincteric pattern of patients with injuries caused by GW with those caused by other trauma mechanisms.
  
  
  RESULTS
  The causes of SCI were (1) gunshot wounds (31 patients: 43.7%); (2) motor vehicle accidents (16 patients: 22.5%); (3) falls (16 patients: 22.5%) and (4) diving (three patients: 4.2%). In five patients (7.1%) the causes were unusual trauma mechanisms like stab wound (one patient) and direct trauma in vigorous sports (two patients) or fights (two patients). The levels of the injuries were cervical in 22 patients (31.0%), thoracic in 39 (54.9%) and lumbar in 10 (14.1%). Detrusor hyperreflexia with detrusor-sphincter dyssynergia was present in 65% of the patients overall and in 76% of the thoracic gunshot wounded. Areflexia occurred in 20% of the patients and in 16% of thoracic injured patients with gunshots. Detrusor hyperreflexia with detrusor-sphincter dyssynergia was the pattern encountered in 50% of the individuals suffering from SCI because of other mechanisms and areflexia was present in 35.8%. There was no statistical difference between GW patients and other mechanisms according to bladder and sphincter functions.
  
  
  CONCLUSIONS
  There was a substantial overlap of bladder and sphincteric behaviors between patients with different levels of spinal injuries, but the trauma mechanism was not important to determine the bladder and sphincteric functions.
authors.affiliation: Division of Urology, University of Sao Paulo School of Medicine, Sao Paulo, Brazil.
authors.forename: C A R
authors.initials: CA
authors.lastname: Sacomani
authors.forename: F E
authors.initials: FE
authors.lastname: Trigo-Rocha
authors.forename: C M
authors.initials: CM
authors.lastname: Gomes
authors.forename: J A
authors.initials: JA
authors.lastname: Greve
authors.forename: T E P
authors.initials: TE
authors.lastname: Barros
authors.forename: S
authors.initials: S
authors.lastname: Arap
mesh_terms: D000058:Accidental Falls; D000063:Accidents, Traffic; D000293:Adolescent; D000328:Adult; D001938:Brazil; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013119:Spinal Cord Injuries / Q000209:etiology / Q000503:physiopathology*; D013550:Swimming / Q000293:injuries; D001750:Urinary Bladder, Neurogenic / Q000209:etiology / Q000503:physiopathology*; D014563:Urodynamics; D014948:Wounds, Gunshot