Detrusor hyperreflexia in neurogenic bladder disorders caused by localized partial lesions of the spinal cord and cauda equina

Gunasekera, W.S.L.; Richardson, A.E.; Seneviratne, Kalinga; Eversden, I.D.

doi:10.1016/0090-3019(83)90109-x

Cited by 7 publications

(7 citation statements)

References 7 publications

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“…The type of detrusor overactivity in our series of patients was of compliant type, except for 2 cases with overactive detrusor accompanied with low compliance (of not rhythmic nature). Therefore the nature of detrusor overactivity found in our patients was not consistent with that reported by Gunasekera et al [6]. …”

Section: Discussioncontrasting

confidence: 55%

“…Detrusor overactivity, however, has also been reported to occur in other lesions such as benign prostatic hypertrophy [6, 7]. Detrusor areflexia is a typical urodynamic finding in lower lumbar spine lesions [1].…”

Section: Discussionmentioning

confidence: 99%

“…Sharr et al [3]suggested that the cause of detrusor overactivity in lumbar spondylosis was an ischemic disturbance of the conus medullaris caused by compression of the ascending radicular arteries. Gunasekera et al [6]pointed out two types of detrusor hyperreflexia: one was compliant hyperreflexic type associated with upper motor neuron disturbance, in which the hyperreflexia was of reflex nature and bladder compliance was unchanged, and the other was noncompliant hyperreflexic type associated with lower motor neuron disturbance, in which the contractions were of rhythmic nature and accompanied by reduced compliance. The type of detrusor overactivity in our series of patients was of compliant type, except for 2 cases with overactive detrusor accompanied with low compliance (of not rhythmic nature).…”

Section: Discussionmentioning

confidence: 99%

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Detrusor Overactivity and Penile Erection in Patients with Lower Lumbar Spine Lesions

Yamanishi

Yasuda²,

Sakakibara³

et al. 1998

European Urology

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Section: Discussioncontrasting

confidence: 55%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Detrusor Overactivity and Penile Erection in Patients with Lower Lumbar Spine Lesions

Yamanishi

Yasuda²,

Sakakibara³

et al. 1998

European Urology

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“…15,16 It is well known that patients with cauda equina injury involving the sacral cord containing the pelvic nucleus and the pudendal nucleus, typically show the high compliance are¯exic neurogenic bladder, but the low compliance and/or small volume bladder is also clinically encountered in these patients. In the study done by Gunasekera et al, 4 16 of 34 subjects showed low compliance, and low compliance bladder was observed in 28% of our patients in this study. When low compliance bladder was compared with the normal compliance group, the interval between the onset of injury and the initiation of rehabilitative treatment was signi®cantly longer, and there were a higher number of voiding methods either by Crede's maneuver or by indwelling catheter prior to admission.…”

Section: Discussionsupporting

confidence: 60%

“…In this study, six (42.9%) out of 14 patients with low compliance bladder had ADC, and these patients showed a signi®cant decrease in the compliance and capacity of the bladder compared to those without ADC. The study done by Gunasekera et al, 4 reported that among 34 patients with lower motor neuron injury, detrusor hyperre¯exia was observed in 20 patients. Among these 20 patients, low compliance bladder was found in 16 and normal compliance in four.…”

Section: Discussionmentioning

confidence: 97%

Significance of low compliance bladder in cauda equina injury

Shin

Kim

et al. 2002

Spinal Cord

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Study design: Prospective investigation using serial urodynamic studies. Objective: To evaluate type of neurogenic bladder and to observe changes of autonomous detrusor contraction (ADC) after the normalization of the compliance and capacity of the bladder in cauda equina injury. Setting: Spinal Cord Injury Unit, Yonsei Rehabilitation Hospital, Seoul, Korea. Methods: Urodynamic studies were performed in 50 patients with complete cauda equina injury from trauma with an infusion ratio of 30 ml/min. Findings of urodynamic studies and clinical features of patients with low compliance were compared with those of the normal compliant patients. Fourteen patients with low compliance received oral administration of oxybutynin and propiverine and intravesical instillation of oxybutynin to increase the compliance and capacity of the bladder, and follow-up urodynamic studies to monitor the change were undertaken. Results: Bladder compliance was decreased in 14 (28%) patients and normal in 36 (72%) patients. There was a signi®cantly long time interval between the onset of injury and the initiation of rehabilitative treatment in the neurogenic bladder group with low compliance when compared to those of the normal compliance group (P50.05). Clean intermittent catheterization was used as the voiding method, signi®cantly less than the normal compliance group (P50.05). ADC was observed in six out of fourteen patients with low compliance neurogenic bladder, but none in the normal compliance group. Upon the completion of conservative treatment, ADC disappeared in four patients whose compliance and capacity of the bladder were normalized on follow-up urodynamic studies. Conclusion: ADC was only observed in the low compliant bladder and as ADC disappeared when compliance and capacity of the bladder was normalized; low compliance appeared to be the main cause of ADC. In addition, this study supports that the maintenance of compliance of the bladder may be the most important factor in the management of neurogenic bladder.

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Urologic Changes After Cauda Equina Compression in Dogs

et al. 1990

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Relative degrees (25%, 50% or 75%) of constriction of the entire cauda equina at the seventh lumbar level were performed on eighteen pure bred female beagle hounds by surgically implanting a circular polyethylene loop with an imbedded stainless steel wire. The wire was mechanically constricted by external control and the degree of compression was confirmed by pre- and postoperative magnetic resonance imaging or computed tomography scanning. A control group of two dogs had laminectomy only. Neurologic function was evaluated daily. Cystometrics were performed on each dog after constriction had been present for three months. Cortical evoked potentials (CEPs) were obtained on all dogs preoperatively, immediately following constriction and at monthly intervals for three months. Dogs were sacrificed at three months and the cauda equina and spinal cord were examined histopathologically. Cystometric tracings were noted to become a flat line with 75% compression of the cord. Less compression had minimal effect on the cystometric curves. The mean latency, determined by cortical evoked potentials, was noted to increase by 3.2%, 7.8%, and 17.2% immediately after 25%, 50% and 75% constriction, respectively. Histologic changes ranged from occasional enlargement of the axons on the periphery of the cauda equina with 25% constriction to severe loss of all axons and atrophic roots at the level of the constricting band with 75% constriction.

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Detrusor hyperreflexia in neurogenic bladder disorders caused by localized partial lesions of the spinal cord and cauda equina

Cited by 7 publications

References 7 publications

Detrusor Overactivity and Penile Erection in Patients with Lower Lumbar Spine Lesions

Detrusor Overactivity and Penile Erection in Patients with Lower Lumbar Spine Lesions

Significance of low compliance bladder in cauda equina injury

Urologic Changes After Cauda Equina Compression in Dogs

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