Study design: Analysis of answers to a new questionnaire. Objective: To examine current practice patterns of physicians in the urological surveillance and management of spinal cord injury (SCI) patients in Japan. Setting: Nationwide questionnaire survey to physicians in Japan. Methods: A Japanese version of the 14-item questionnaire survey carried out in US was mailed to 770 members of the Japanese Neurogenic Bladder Society (JNBS). Results: We received answers to our questionnaire from 333 (43.2%) members of JNBS. The responders were all urologists. The management of lower urinary tract (LUT) disorders is very important in order to prevent serious complications that may result in upper urinary tract (UUT) disorders such as hydronephrosis. There have been arguments as to the strategy of observation and therapeutic approaches in SCI patients. For improvement in life expectancy and quality, research and evidenced-based practices related to urinary tract dysfunction are requisite. Recently, results of questionnaires on the current practice patterns in urological surveillance and management of SCI patients were reported in the United States (US) and United Kingdom (UK).3,4 The present inquiry by questionnaire was performed on the current practice patterns of the physician (urologist) in urological management of SCI patients in Japan. Spinal Cord (2006) 44, 362-368 & 2006 International Spinal Cord Society All rights reserved 1362-4393/06 $30.00 www.nature.com/sc MethodsA Japanese version of the 14-item questionnaire (see Appendix A) with which a survey was carried out recently in the US 3 was mailed to 770 members of the Japanese Neurogenic Bladder Society (JNBS) in January 2004. The society consists of urologists, neurologists, pharmacologists, and others. More than 90% of the members of the society are urologists. The number of urologists of JNBS is approximately 10% of the total members of the Japan Urological Association (JUA), which is the only official society of urologists in Japan. We thought that almost all of the members of JNBS were engaged more routinely in urologic management of patients with SCI than those of any other nationwide academic medical society. Answers to the questionnaire returned to us by the deadline (within 1 month) were analyzed in this study. The first eight questions concern surveillance of the neuropathic bladder and bladder cancer due to spinal cord lesions, and the remaining questions deal with treatment modality and background of the respondents. The US and Japanese questionnaires were not identical, because Razden et al 3 did not publish details of their questionnaire. ResultsWe received a response to our questionnaire from 388 (50.3%) members of JNBS. In all, 55 members declined to answer our questions because they were not engaged in urological management of SCI patients. A total of 333 (43.2%) urologists out of the JNBS members replied to our questions. Some of them did not answer all questions in the questionnaire because of unknown reasons. In total, 314 (40.8%) urologists a...

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Bladder and urethral functions were evaluated urodynamically in 114 patients with lumbar disorders including prolapsed lumbar intervertebral disc (66 patients), lumbar canal stenosis (19 patients), lumbar spondylolysis and/or spondylolisthesis (21 patients), lumbar spondylosis deformans (5 patients) and ossification of the yellow ligament of the lumbar spine (3 patients). The patients consisted of 88 males and 26 females with an average age of 47 years (range 17 to 73 years). Symptomatic organic infravesical obstruction was excluded by physical and radiographic examination. Cystometry revealed preoperative neurogenic bladder in 23 patients (20%); normal detrusor with overactive sphincter in 2 (9%), underactive in 8 (36%), overactive in 5 (23%) and equivocal in 7 (32%). One patient not receiving cystometry revealed abnormal uroflowmetry with 140 ml residual urine. Twenty of them underwent electromyographic examination of the external sphincter and 15 (75%) had an overactive sphincter. Nine (39%) of them complained no urological symptoms. Neurogenic bladder seemed to highly associate in those having abnormal tendon reflex in the lower extremities, decreased bulbocavernosus reflex and sensory disturbance in the perineal area, but there was no statistical significance. Of twenty-three neurogenic bladder patients, eighteen underwent a lumbar vertebral operation and fifteen received postoperative urodynamic evaluation. Uroflowmetry was improved in more than half of the patients within 3 months after the operation and cystometry was normalized in 4 of 7 patients who underwent cystometry over 6 months after the operation. Preoperative overactive detrusor remained unchanged in two of three patients who underwent cystometry over 6 months after the operation.

Study design: A retrospective study. Objectives: To investigate the risk factors of vesicoureteral re¯ux in the early stage of spinal cord injury. Setting: Japan. Methods: Urological evaluation, including cystography and urodynamic study was performed in patients in the early stage of spinal cord injury. The patients were divided into two groups. Group 1 included 13 patients with vesicoureteral re¯ux. Group 2 included 97 patients without vesicoureteral re¯ux. We compared Group 1 and Group 2 regarding bladder deformation, the level of spinal cord injury, bladder behaviour, bladder compliance, high urethral closure pressure and method of urine evacuation. Results: The patients injured between Th10 and L2 showed a signi®cantly higher incidence of vesicoureteral re¯ux than those injured in other areas (P50.01). Furthermore, bladder compliance among patients with vesicoureteral re¯ux tended to be low. Other factors showed no di erences between patients with and without vesicoureteral re¯ux.

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