A critical review of urodynamic investigations in spinal cord injury patients

Wyndaele, J J

doi:10.1038/sc.1984.26

Cited by 17 publications

(10 citation statements)

References 8 publications

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“…In a previous series of 103 patients, the correlation between the type of bladder dysfunction and the level of the SCL was even better. 15 Bladder are¯exia and a¯accid paralysis of the striated sphincter may occur due to vascular damage of the cord under the lesion in up to one third of the cases. 4 The coexistence of a second subclinical lesion at a di erent level, a variability in cord to column correlation and damage to the detrusor muscle from overdistension, eg during spinal shock may be other cause of are¯exia.…”

Section: Discussionmentioning

confidence: 99%

Correlation between clinical neurological data and urodynamic function in spinal cord injured patients

Wyndaele

1997

Spinal Cord

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In 92 patients with spinal cord lesion, out of spinal shock, the data from a clinical neurological examination of the lumbosacral area are compared with the data from a full urodynamic investigation, including evaluation of sensation in the lower urinary tract. A signi®cant correlation can be found between di erent levels of spinal cord lesion, the function of bladder neck and sphincter and the anal bulbocavernosus re¯exes. Higher lesions correspond more with a re¯exic lower urinary tract and somatic motor activity, lower lesions more with are¯exia. With a lesion between thoracic 10 and lumbar 2 as many re¯exic as are¯exic lower urinary tract dysfunctions were found. The presence or absence of perineal sensation of light touch corresponded signi®cantly with the presence or absence of sensation in the lower urinary tract. Detrusor and striated sphincter re¯exia/are¯exia corresponded signi®cantly with the presence/absence of bulbocavernosus and anal re¯exes. Clinical neurological examination gives useful information which acceptably corresponds with the LUT function. However to decide on a detailed individual diagnosis, clinical examination is in our opinion insu cient. Urodynamic tests are needed for a profound evaluation of the function of di erent parts of the lower urinary tract and their interaction.

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Section: Discussionmentioning

confidence: 99%

Correlation between clinical neurological data and urodynamic function in spinal cord injured patients

Wyndaele

1997

Spinal Cord

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“…14 In such urodynamic investigation, the main interest usually concerns motor function evaluation. 15 Few publications deal with the sensory function of the lower urinary tract, though the afferent innervation is of the upmost importance for motor function. 16,17 Information about the afferent innervation of the lower urinary tract after SCI can also be important from a pathophysiological point of view, as the sensory path way travels practically the entire length of the central nervous system.…”

Section: IImentioning

confidence: 99%

Investigation of the afferent nerves of the lower urinary tract in patients with ‘complete’ and ‘incomplete’ spinal cord injury

Wyndaele¹

1991

Spinal Cord

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SummaryIn 52 patients with a post-traumatic spinal cord lesion, both proprioception and extero ception in the lower urinary tract were investigated by determination of filling perception and with sensory threshold measurement towards electrical stimulation. Patients with incomplete lesions had one or both types of perception.Of the 42 patients, with a lesion diagnosed clinically as complete, 15 perceived bladder filling, electrical stimulation or both slimuli, indicating the existence..of a nervous afferent pathway between the lower urinary tract and the cerebral cortex.

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“…If a detrusor contraction is weak or unsustained, this information will indicate that the patient may be at risk of developing retention after a while. 6 Depending on the circumstances of the patient, the spinal unit, and the home situation, intermittent catheterisation by carers with close follow-up should be begun and patients should not be simply left with indwelling catheter drainage. Bladder pressure developed spontaneously or on provocation, duration of detrusor contraction, frequency of detrusor contractions, detrusor-sphincter interaction, and detrusor-bladder neck interaction, which will become evident if videourodynamics are used, provide useful information in management of SCI patients, who undergo TOM.…”

Section: Discussionmentioning

confidence: 99%

“…In SCI patients, the dose of potentially nephrotoxic antibiotics should be adjusted on an individual basis. 12 (6) Beware of possible interaction between antibacterials and warfarin. If an SCI patient, who is undergoing TOM, has been taking warfarin, check INR at more frequent intervals.…”

Section: Discussionmentioning

confidence: 99%

Flawed trial of micturition in cervical spinal cord injury patients: guidelines for trial of voiding in men with tetraplegia

et al. 2003

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Study design: A retrospective study. Objectives: (1) To raise awareness of flawed trial of micturition (TOM) in male spinal cord injury (SCI) patients; and (2) to present guidelines for trial of voiding in male SCI patients. Setting: Regional Spinal Injuries Centre, Southport, UK. Methods: Trial of micturition in male SCI patients refers to discarding indwelling catheters and establishing them on balanced voiding with penile sheath drainage. We describe seven SCI patients, whose trial of micturition was flawed. Results: Two patients (C-6 and C-4 tetraplegia respectively) developed severe autonomic dysreflexia (headache, sweating, and increase in blood pressure) 2-3 h after removal of urethral catheter. A C-4 tetraplegic developed severe urinary infection after TOM. Four patients with tetraplegia started retaining increasing amounts of urine and developed urinary infections/ autonomic dysreflexia/hydronephrosis 1-21 months after they were established on sheath drainage after TOM. Conclusion: During TOM, patients with cervical SCI could develop autonomic dysreflexia, urinary infection, or hold progressively increasing volumes of residual urine. TOM should be guided by videourodynamics. SCI patients need a-blockers, and anticholinergics if voiding pressures are 440-50 cmH 2 O. If high urethral resistances are found, sphincterotomy and/or bladder neck incision will help the patients to void by triggering. SCI patients, who had undergone successful TOM, require meticulous follow-up including urodynamics. Intermittent catheterisation without adequate medications based on cystometrogram may be hazardous, and may result in upper tract damage. Facilities for supplementary catheterisation (three to four times a day) should be available in the community if a patient is unable to maintain complete, low-pressure, emptying of bladder.

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A critical review of urodynamic investigations in spinal cord injury patients

Abstract: Summary. Urodynamic investigations carried out on 108 patients with an acute spinal cord injury were reviewed. Both clinical neurological examination and technical urodynamic investigations proved to be of great value in the management of the neuropathic bladder.

Cited by 17 publications

References 8 publications

Correlation between clinical neurological data and urodynamic function in spinal cord injured patients

Correlation between clinical neurological data and urodynamic function in spinal cord injured patients

Investigation of the afferent nerves of the lower urinary tract in patients with ‘complete’ and ‘incomplete’ spinal cord injury

Flawed trial of micturition in cervical spinal cord injury patients: guidelines for trial of voiding in men with tetraplegia

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