Bladder-filling sensation in patients with spinal cord injury and the potential for sensation-dependent bladder emptying

Ersöz, Murat; Akyuz, Müfit

doi:10.1038/sj.sc.3101525

Cited by 34 publications

(49 citation statements)

References 32 publications

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“…Further, rectal stimulation showed cortical activation in areas of the brain similar to healthy volunteers. Their assertion is supported by other studies in which SCI patients describe sensation in the bladder, 12,13 genital stimulation 14 and anorectal sensation. 15,16 In another study using MRI, Samdani et al 17 describes a patient who was clinically tested as incomplete, but had complete disruption of their spinal cord.…”

Section: Discussionsupporting

confidence: 66%

The international standards for neurological classification of spinal cord injury: relationship between S4-5 dermatome testing and anorectal testing

et al. 2010

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Study design: Prospective cross-sectional multicenter study. Objective: To evaluate the correlation, sensitivity, specificity and predictive values of S4-5 dermatome and the anorectal examination for determination of sacral sparing in the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) examination. Setting: Two tertiary hospitals that specialize in pediatric spinal cord injuries. Methods: In all, 189 patients who were at minimum 3 month after spinal cord injury participated in complete ISNCSCI examinations. All examiners completed training for the proper completion of the ISNCSCI examination. Correlations and sensitivity/specificity analyses were conducted between S4-5 dermatome testing and the anorectal examination. Results were analyzed by age of patient, examiner, tetraplegia/paraplegia classification and injury level (T10-S3, L1-S3 and S3). Results: The correlation between S4-5 dermatome and anorectal sensation was moderate (0.62, Po0.001). Using the anorectal examination as the gold standard, the sensitivity of S4-5 testing was 0.60 (0.49, 70) and specificity was 0.96 (0.90, 0.99). No single age group, tester, level, or type of injury differed from the overall result. Conclusion: In the pediatric population, the correlation between S4-5 and anorectal sensation was lower than anticipated. The sensitivity of 0.62 for S4-5 testing and diminished sensation between T10 and S3 suggests that anorectal testing may either be a more sensitive representation of S4-5 function or activate an alternative neuronal pathway that is perceived by the patient. Further investigation into the validity of the sacral sparing components of the ISNCSCI examination is warranted.

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Section: Discussionsupporting

confidence: 66%

The international standards for neurological classification of spinal cord injury: relationship between S4-5 dermatome testing and anorectal testing

et al. 2010

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“…The presence of bladder-filling sensation may be useful in the timing of bladder emptying. 9 As the loss of bladder-filling sensation is frequent in the LCSCI group, we feel that strict and close follow-up for the bladderemptying timing and volume is required in this patient group.…”

Section: Discussionmentioning

confidence: 99%

“…The patients were informed about the bladder-filling sensations (the first sensation of bladder filling, the first desire to void and a strong desire to void) before the investigation and were asked to report all sensations related to bladder filling, but not to report if they do not feel anything. [7][8][9] Filling was terminated when the patient had a strong desire to void, when significant leakage occurred, when intravesical pressure reached 40 cm H 2 O, observation of autonomic dysreflexia (AD) and blood pressure changes (systolic blood pressure 4140 mm Hg or 20-40 mm Hg increase in the systolic blood pressure in adults and 15 mm Hg increase in the systolic blood pressure in children 10 ). The detrusor type and compliance, bladder-filling sensation, expected bladder capacity for children, maximum cystometric capacity, volume of micturated urine and residual volume were analyzed.…”

Section: Methodsmentioning

confidence: 99%

“…9 The compliance was considered as normal when the detrusor pressure was X20 ml per cm H 2 O and it was considered as hypocompliance when the detrusor pressure was o20 ml per cm H 2 O. 11 The expected bladder capacity was calculated according to the age formula in the children (for children o2 years old: (2 Â age þ 2) Â 28 ml and for children 42 years old: (age/2 þ 6) Â 28 ml).…”

Section: Methodsmentioning

confidence: 99%

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Comparison of urodynamic findings in patients with upper and lower cervical spinal cord injury

2013

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Study design: Retrospective study.Objectives: To analyze the neurogenic bladder characteristics and treatment approaches in patients with upper and lower cervical spinal cord injury (SCI) in order to make proper and reasonable decisions to the relevant patients. Setting: Rehabilitation center in Ankara, Turkey. Method: Ninety patients with cervical SCI were included. The urodynamic analyses of the patients were conducted retrospectively by using the urodynamic laboratory records. The patients were divided into two groups as the upper cervical SCI (UCSCI) group (C1-C5) and lower cervical SCI (LCSCI) group (C6-C8). Results: In this study, 82 male (91.1%) and 8 (8.9%) female patients were included. There were 51 UCSCI patients with the mean age of 34.2 ± 16.1 years and 39 LCSCI patients with the mean age of 30.4 ± 12.5 years. Detrusor overactivity and preservation of the bladder-filling sensation were significantly more frequent in the UCSCI group than in the LCSCI group (P ¼ 0.048, P ¼ 0.000 respectively). Moreover, there were statistically significant differences between the groups regarding the bladder-emptying methods, residual volume and the frequency of anticholinergic and alpha blocker use (all Po0.05). No significant difference was found between the groups regarding the frequency of autonomic dysreflexia, detrusor hypocompliancy and the bladder-storage and -emptying disorders (all P40.05). INTRODUCTIONSpinal cord injury (SCI) is a disease that is resulted by traumatic or nontraumatic reasons, and it causes restriction of self-care, mobilization and daily activities of the patients to a considerable degree. The SCI incidence was reported to be 15-40 per million. 1,2 The damage as a result of this injury not only limits the movement of the patient but also causes vital changes in the functions of many organs and lead to life-threatening complications. The aforementioned problems are more severe in cases of cervical SCI. Neurogenic bladder is commonplace in SCI patients. It decreases life span and adversely affects the quality of life. [3][4][5][6] Although the neurogenic bladder was one of the most important cause of morbidity/mortality in SCI patients in the past when the examination and treatment were not sufficiently developed, it has reached to a curable level today as a result of new developments.The purpose of this study was to analyze the neurogenic bladder characteristics and treatment approaches retrospectively in the cervical SCI cases by using the urodynamic records of our hospital. As there were some differences in the functional abilities like hand function, sitting balance, and so on in upper (C1-C5) and lower (C6-C8) cervical SCI patients, we hypothesized that neurogenic bladder characteristics and treatment approaches would also differ in these groups. The aim of this study was to make proper and reasonable decisions for the neurogenic bladder treatment approaches in relevant patients with cervical SCI.

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“…In the vast majority of clinical urodynamic studies, 50 ml/min has been the preferred filling rate (7,9). However, this type of filling sometimes provokes detrusor contractions and may cause incorrect bladder capacity determinations.…”

Section: ö öZ Ze Et Tmentioning

confidence: 99%

Comparison of Continuous and Intermittent Filling Cystometry in Patients with Spinal Cord Injury

Kaya¹,

Ersöz²,

Koyuncu³

et al. 2010

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S Su um mm ma ar ry y O Ob bj je ec ct ti iv ve e: : Continuous medium filling cystometry at a rate of 50 ml/min is a widely used method due to its advantages such as short filling time and published reference values. However, this type of filling sometimes provokes detrusor contractions and may cause incorrect bladder capacity determinations. The aim of this study was to compare the continuous and intermittent filling during cystometry in patients with spinal cord injury (SCI) who had detrusor overactivity. M Ma at te er ri ia al ls s a an nd d M Me et th ho od ds s: : Twenty patients with SCI who had detrusor overactivity were included in the study. After the drainage of all urine, first, the bladder was filled continuously at a filling rate of 50 ml/min with sterile physiological saline at room temperature and the maximum cystometric capacity was determined. After the continuous filling cystometry, the bladder was emptied again and filled intermittently by 30 seconds filling followed by 15 seconds pause periods at filling rate of 50 ml/min. The maximum cystometric capacities observed during continuous and intermittent filling were compared by the Wilcoxon signed rank test. R Re es su ul lt ts s: : The mean maximum cystometric capacities were 86.5±43.7 ml and 122.7±62.2 ml, respectively in continuous and intermittent filling (p<0.001). The mean increase in intermittent filling was 36.2±38.1 ml, which represented a 41.84% mean increase. C Co on nc cl lu us si io on n: : In this study, higher cystometric capacities were observed in SCI patients with overactive detrusors by intermittent filling. This method may serve determination of bladder capacity more correctly and may contribute to make appropriate therapeutic decisions in patients with detrusor overactivity. Turk J Phys Med Rehab 2010;56:67-70. K Ke ey y W Wo or rd ds s: : Intermittent filling, cystometry, spinal cord injury, overactive urinary bladder Ö Öz ze et t A Am ma aç ç: : Elli ml/dk h›zda yap›lan orta h›zl› sürekli dolum sistometrisi dolum süresinin k›sal›¤› ve yay›nlanm›fl referans de¤erlerinin oluflu gibi avantajlar› nedeniyle yayg›n olarak kullan›lan bir metotdur. Bununla birlikte bu tip dolum bazen detrüsör kontraksiyonlar›n› provoke edebilir ve mesane kapasitesini saptamada hatalara neden olabilir. Bu çal›fl-man›n amac› afl›r› aktif detrüsöre sahip omurilik yaralanmal› (OY) hastalarda sürekli ve aral›kl› dolumla yap›lan sistometrik ölçümlerin karfl›-laflt›r›lmas›d›r. G Ge er re eç ç v ve e Y Yö ön nt te em m: : Çal›flmaya afl›r› aktif detrüsöre sahip OY'li 20 hasta dahil edildi. Mesanedeki tüm idrar boflalt›ld›ktan sonra, mesane ilk ön-ce oda s›cakl›¤›ndaki steril serum fizyolojik ile 50 ml/dk h›zla sürekli olarak dolduruldu ve mesane kapasitesi belirlendi. Sürekli dolum sistometrisinden sonra mesane tekrar boflalt›ld› ve 50 ml/dk dolum h›z›yla 30 saniyelik dolum periyodlar›n› izleyen 15 saniyelik duraklamalarla aral›kl› olarak dolduruldu. Sürekli ve aral›kl› dolum s›ras›nda saptanan kapasiteler Wilcoxon iflaretli s›ra testi ile karfl›laflt›r›...

show abstract

Bladder-filling sensation in patients with spinal cord injury and the potential for sensation-dependent bladder emptying

Cited by 34 publications

References 32 publications

The international standards for neurological classification of spinal cord injury: relationship between S4-5 dermatome testing and anorectal testing

The international standards for neurological classification of spinal cord injury: relationship between S4-5 dermatome testing and anorectal testing

Comparison of urodynamic findings in patients with upper and lower cervical spinal cord injury

Comparison of Continuous and Intermittent Filling Cystometry in Patients with Spinal Cord Injury

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