Neurogenic Bladder in Patients With Lumbar Vertebral Disorders

Abstract

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.

Neurogenic lower urinary tract dysfunction in association with severity of degenerative spinal diseases: Short‐term outcomes of decompression surgery

“…Among examined patients, 59.8% with CM and 64.0% with LCS displayed moderate-severe urinary symptoms (IPSS ≥ 8), comparable with results from past studies. [8][9][10][11][12][13][14][15][16] Interestingly, there was little difference in preoperative parameters between CM and LCS. However, degenerative spinal diseases are considered to affect the lower urinary tract in various mechanisms depending on spinal levels.…”

“…The presence of not only DU but also DO and DSD has been demonstrated in LCS patients by urodynamic studies. 14,16 DO is considered to be attributable to hyperirritability of sacral roots or ischemic disturbance of the conus medullaris while DU may occur more frequently with progressed compression due to sensory loss. 14,25,26 Urodynamic studies including pressure flow studies are the principal procedure to diagnose neurogenic bladder.…”

“…14,16 DO is considered to be attributable to hyperirritability of sacral roots or ischemic disturbance of the conus medullaris while DU may occur more frequently with progressed compression due to sensory loss. 14,25,26 Urodynamic studies including pressure flow studies are the principal procedure to diagnose neurogenic bladder. However, such invasive examinations are difficult to perform for all patients with T A B L E 4 Postoperative change of uroflowmetry and JOA scores in a followed-up cohort absence of significant pelvic organ prolapse in women.…”

“…5 Meanwhile, the number of operations increased 3-fold for CM and 10-fold for LCS in 25 years between 1988 and 2012 due to the aging of the population. 6 With these increasingly prevalent degenerative spinal diseases, lower urinary tract symptoms (LUTS) are common, at 47% to 81% in CM [7][8][9][10][11][12] and 41% to 88% in LCS patients, [13][14][15][16] and both diseases reportedly present with storage and voiding symptoms. Major orthopedic symptoms of CM are neck pain, numbness and loss of dexterity of the upper limb, stiffness and sensory loss in the lower limbs, and gait impairment.…”

Canal lombaire étroit et troubles vésicosphinctériens: à propos de 49 observations

“…Le débit maximal était également amé-lioré ; en revanche, il n'était pas constaté de changement de la cystographie, de l'électromyographie ni de la capacité vésicale. Hellström [28]. Cela pour souligner le fait que dans nombre de cas, la pathologie urinaire peut passer tout à fait inaperçue.…”