Urodynamic patterns following ischemic spinal cord events.
OBJECTIVE
The nature of bladder function following ischemic injuries to the spinal cord (vSCI) is poorly understood. We describe urodynamic (UD) findings in patients with vSCI and determined the optimal management of voiding dysfunction.


METHODS
From January 1997 through September 2001, 18 patients were diagnosed with vSCI. All underwent neurological and urodynamic evaluation. The etiology of vSCI was abdominal aortic aneurysm repair in 10 patients, another surgical procedure in 4 and a spontaneous spinal cord infarct in 2.


RESULTS
Two patients (American Spinal Injury Association [ASIA] class A) had detrusor areflexia or hyporeflexia and performed clean intermittent catheterization. Of the 10 patients assigned to ASIA class C 50% had UD evidence of abnormal compliance, unstable detrusor contractions and detrusor-external sphincter dyssynergia (DESD). All 10 patients had thoracic or cervical sensory levels and 60% had detrusor hyporeflexia or areflexia. A single patient voided spontaneously, while the remainder performed continuous or intermittent catheterization. Five patients assigned to ASIA class D had no abnormal compliance, unstable detrusor contractions or DESD. Four patients voided spontaneously or by abdominal straining. The patients with a history of abdominal aortic aneurysm repair were a heterogeneous population.


CONCLUSIONS
While the etiology or sensory level of vSCI does not appear to predict UD patterns with consistency, greater preservation of motor function may be associated with improved parameters. All patients with vSCI and lower urinary tract symptoms require thorough UD evaluation and ongoing surveillance is mandated because deterioration may develop with time. Clean intermittent catheterization may represent the most effective method of bladder emptying for patients unable to void voluntarily. However, early evidence of abnormal compliance and DESD has also been seen in these patients, underscoring the need for close UD surveillance.
Gomelsky
Alex
A
Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.
Lemack
Gary E
GE
Weld
Kyle J
KJ
Dmochowski
Roger R
RR
D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery; D006801:Humans; D007238:Infarction / Q000150:complications; D007511:Ischemia / Q000150:complications / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D013116:Spinal Cord / Q000098:blood supply*; D014555:Urination Disorders / Q000209:etiology / Q000503:physiopathology*; D014563:Urodynamics