The Relationship Between Level of Injury and Bladder Behaviour in Patients with Post-Traumatic Spinal Cord Injury

BACKGROUND
After the spinal shock period, suprasacral injuries classically result in detrusor hyperreflexia/overactive bladder and detrusor sphincter dyssynergia. Sacral cord injuries produce detrusor areflexia consistent with lower motor neuron injury and often increased bladder compliance. However, previous investigators have noted an inexact correlation between spinal cord injury level and urodynamic findings. The aim of this study was to evaluate the relationship between level of injury and urodynamic findings.
METHODS
Fifty-one patients with post-traumatic spinal cord injury were classified by the radiographically determined level of injury, clinical neurologic level and completeness of injury. Urodynamic studies were performed in all patients.
RESULTS
Twenty-six of 36 patients with suprasacral injuries had hyperreflexia/overactive bladder (72.2%). Twenty-nine (80.5%) had detrusor sphincter dyssynergia, 9 (25%) had normal compliance and 1 (2.8%) had areflexia. Six of the 14 patients with sacral injuries had areflexia (42.8%), 2 (14.3%) had hyperreflexia/overactive bladder, 2 (14.3%) had detrusor sphincter dyssynergia, and 6 (42.8%) had normal compliance.
CONCLUSION
The correlation between somatic neurologic findings or spinal imaging studies and urodynamic findings in patients with spinal cord injury is not exact. These data suggest that the neurologic examination alone is not an adequate parameter to predict urological dysfunction and that urodynamic evaluation provides a more precise diagnosis for each patient.

Post-Travmatik Spinal Kord Lezyonlu Hastalarda Travma Seviyesi ile Mesane Davranýþý Arasýndaki Ýliþki

AMAÇ
Spinal þok dönemi sonrasý, suprasakral lezyonlar klasik olarak detrusor hiperrefleksisi (veya aþýrý detrusor aktivitesi) ve detrusor sfinkter dissinerjisi ile sonuçlanýr. Sakral lezyonlar ise alt motor nöron hasarý ile arefleksif mesane ve yüksek mesane kompliyansý ile kendini gösterir. Buna raðmen bazý yazarlar spinal kord travmasý ile ürodinamik bulgularýn her zaman korele olmadýðýný göstermiþtir. Bu çalýþmada, travma seviyesi ile ürodinamik bulgularýn iliþkisi deðerlendirildi.
GEREÇ VE YÖNTEM
Posttravmatik spinal kord lezyonlu 51 hasta radyolojik olarak belirlenen travma seviyesi, travmanýn nörolojik seviyesi ve spinal hasarýn þiddetine göre sýnýflandýrýldý. Daha sonra tüm hastalara ürodinami iþlemi uygulandý.
BULGULAR
Suprasakral lezyonlu 36 hastanýn 26’sýnda (%72,2) hiperrefleksi ya da aþýrý detrusor aktivitesi (p<0,05), 29’unda (%80,5) detrusor sfinkter dissinerjisi (p<0,05), 9’unda (%25) normal kompliyans ve 1’inde (%2,8) arefleksi saptandý. Sakral lezyonlu 14 hastadan 6’sýnda (%42,8) arefleksi, 2’sinde (%14,3) hiperrefleksi ya da aþýrý detrusor aktivitesi, 2’sinde detrusor sfinkter dissinerjisi ve 6’sýnda (%42,8) normal kompliyans saptandý.
SONUÇ
Spinal kord travmalý hastalarýn somatik nörolojik bulgular veya görüntüleme yöntemlerinde saptanan seviye ile ürodinamik bulgular arasýnda her zaman korelasyon olmayabilir. Bu çalýþma tek baþýna klinik nörolojik muayenenin ürolojik disfonksiyonu tahmin etmede uygun bir parametre olmadýðýný, ürodinamik deðerlendirmenin her hasta için kesin taný koyabilen yöntem olduðunu göstermiþtir.