Correlation between the Findings of a Clinical Neurological Examination and the Urodynamic Dysfunction in Children with Myelodysplasia

Abstract

Clinical neurological findings in 47 children with lumbosacral myelodysplasia did not correlate well with the existing dysfunction of the lower urinary tract as diagnosed by urodynamic studies. The level of intact skin sensation, and the presence or absence of bulbocavernosus and anal reflexes could not significantly predict the function of the detrusor muscle, proximal urethra and striated urethral sphincter. Therefore, one should not rely on a clinical neurological examination to outline the urological management in such patients.

Uroneurological assessment of spina bifida cystica and occulta

“…Absent bulbocavernosus re£ex was noted in 87% and 56% and absent anal re£ex in 100% and 57% of each group, respectively. Neurogenic motor unit potentials were found in one patient with the cystic form and in two of three with the occult form, respectively, evidence of external sphincter denervation re£ecting lesions in the sacral Onuf's nucleus or its e¡erent ¢bers.Therefore, it is likely that the combination of upper and lower neuron types of bladder and sphincter dysfunction is a feature of lumbosacral spina bi¢da [Wyndaele and de Sy, 1985;Welch and Winston, 1987]. In particular, lower neuron type of dysfunction was more common in the cystic form, which is in accordance with the neurological ¢ndings.…”

“…In addition, hyperre£exia of the lower extremities, particularly of patellar tendon re£ex (upper motoneuron sign) was more common in the occult form but absent Achilles tendon re£ex (lower motoneuron sign) was more common in the cystic form. The combination of £accid and spastic paresis is a feature of lumbosacral spina bi¢da [Wyndaele and de Sy, 1985;Welch and Winston, 1987], FS, ¢rst sensation; BC, bladder capacity; VUR, veslcoureteral re£ux; NP, not performed; UPmax, maximum urethral closure pressure; NE, norepinephrine; DSD, detrusor/sphlincter dyssynergia; BCR, bulbocavernosus re£ex; AR, anal re£ex; EMG, electromyogram;…”

Do BPH Patients Have Neurogenic Detrusor Dysfunction? A Uro-Neurological Assessment

“…Lesions in the spinal conus or the cauda equina nerves result in the lower neuron type bladder dysfunction [7], which can appear without obvious neurological manifestation. Spina bifida occulta [29] and LS [30,31] are such diseases, and the latter is particularly common in the elderly individuals. Although none had decreased superficial sensation in the lower extremities, neurological examination showed decreased reflexes in 6 patients.…”

Correlation between History and Urodynamics in Neurologically Normal Incontinent Women

“…However in these a neuro logical disease could not be found. This underlines once again the limitations of neurological clinical examina tions in urological dysfunction as known even in distinct neurological pathology [Wyndaele and DeSy, 1985].…”