Bladder dysfunction in spinal tuberculosis: clinical, urodynamic and MRI study.
METHODS
An observational study.


OBJECTIVE
We report clinical, MRI and urodynamic findings in spinal tuberculosis.


METHODS
Tertiary care teaching hospital.


METHODS
Patients with spinal tuberculosis having micturition disturbances or high postvoidal residual (PVR) urine were subjected to clinical evaluation, urodynamic and spinal MRI. Urinary symptoms were scored as per the American Urological Association Symptom (AUAS) Index. The outcome was defined at 12 months into complete, partial and poor.


RESULTS
Of 30 spinal tuberculosis patients, 15 had micturition disturbance and included urinary retention in 4, stress incontinence in 2, hesitancy in 6, urgency in 11 and urge incontinence in 9 patients. Thirteen patients had paraparesis and one had quadriparesis. Spinal MRI revealed granuloma in 2, dorsal vertebral involvement in 12 and cervical and lumbar vertebral involvement in 1 patient each. On urodynamic study, detrusor hyperreflexia (DH) with high-pressure voiding was present in six, detrusor areflexia (DA) in four, normal study in one and increased PVR urine in the remaining patients. AUAS score improved on follow-up. DA changed to DH with high-pressure voiding in one patient. The 15 patients without micturition disturbance had no horizontal sensory level, milder or no weakness and only 2 had spinal cord signal changes. Patients with micturition disturbances had poorer functional recovery at 1 year compared to those without micturition disturbances.


CONCLUSIONS
Bladder symptoms were present in 50% of the admitted patients with spinal tuberculosis and related to severity of paraplegia, horizontal sensory level, cord signal abnormality and poorer outcome compared to those without spinal tuberculosis. Urodynamic study helped in categorization and management.
Kalita
J
J
Department of Neurology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India. jayanteek@yahoo.com
Misra
U K
UK
Kumar
G
G
Kapoor
R
R
D000328:Adult; D004338:Drug Combinations; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D020127:Recovery of Function / Q000187:drug effects / Q000502:physiology; D013117:Spinal Cord Compression / Q000382:microbiology / Q000473:pathology* / Q000503:physiopathology*; D013904:Thoracic Vertebrae / Q000382:microbiology / Q000473:pathology*; D016896:Treatment Outcome; D014399:Tuberculosis, Spinal / Q000150:complications / Q000473:pathology*; D001750:Urinary Bladder, Neurogenic / Q000382:microbiology / Q000473:pathology* / Q000503:physiopathology*; D014563:Urodynamics / Q000502:physiology; D055815:Young Adult
D004338:Drug Combinations