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Background: Urodynamic evaluation is mandatory in order to correctly assess and classify bladder dysfunction in spinal cord injury (SCI) patients. Study investigated patterns of neurogenic bladder dysfunction in patients with post traumatic spinal cord injury and assessed the relationship of detrusor leak point pressure with compliance, post void residual urine volume and maximum cystometric capacity.Methods: Eighty six patients with neurogenic bladder secondary to traumatic spinal cord injury (SCI) underwent cystometry with electromyography (EMG). T-test was used to compare detrusor leak point pressure (LPP) between complete and incomplete injury groups. Pearson correlation test was used to seek correlation between detrusor LPP and compliance, post void residual volume (PRV) and maximum cystometric capacity (MCC).Results: Mean detrusor LPP in suprasacral complete injury group, suprasacral incomplete injury group and sacral complete injury was 52±21 cm of H2O, 53±18 cm of H2O and 16±9 cm of H2O respectively. No significant difference in detrusor LPP was found between suprasacral complete and incomplete group on t-Test (p= 0.571068). Significant difference in detrusor LPP was found between suprasacral and sacral group (p= 5.71891E-12). Mean compliance in sacral injury group was 24±16 and in suprasacral complete injury group was 5±6. Mean compliance in suprasacral incomplete injury group was 4±2. Pearson correlation showed negative correlation (r = -0.6918934) between detrusor leak point pressure and compliance (p= 1.2744E-13). Negative correlation (r = -0.311409922) was observed between detrusor leak point pressure and post leak/ void residual urine volume (p= 0.003335033) and between detrusor LPP and maximum cystometric capacity (r = -0.31354), (p= 0.003115).Conclusions: Significant difference in urodynamic parameters exists between sacral and suprasacral injury patients. However there is no significant difference in urodynamic parameters between complete and incomplete injury at suprasacral level.
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OBJECTIVE: To investigate the effect of electroacupuncture (EA) at "Dazhui" (GV14) and "Ciliao" (BL32) on rats with bladder detrusor hyperreflexia (DH) after supersacral spinal cord transection, as well as the mechanism of EA in improving the urinary function by regulating the expression of Wnt-1, β-catenin and Neurogenin 1(Ngn1). METHODS: A total of 48 female Sprague-Dawley rats were randomly divided into sham-operation group, model control group, EA group, and EA control group, with 12 rats in each group. T10 spinal cord transection (SCT) was performed by surgery. The Basso, Beattie and Bresnahan (BBB) score was used to evaluate the motor function of SCT rat, and the Crede technique was used to assist urination. After the urine volume became stable, the urodynamic test was used to determine whether a rat model of DH was successfully established. The rats in the EA group were given EA at GV14 and BL32, and those in the EA control group were given EA (10 Hz/50 Hz, 20 min) at the acupuncture points at 1 cm next to GV14 and BL32 at both sides alternatively. EA was performed once a day for one week. Urodynamic parameters were used to evaluate urinary function. Western blot and immunohistochemistry were used to measure the expression of Wnt-1 and β-catenin in the spinal cord, and immunofluorescence assay was used to measure the expression of Ngn1 in the spinal cord. RESULTS: The BBB score of the model control group significantly decreased compared with that of the sham-operation group(P<0.01), and the EA group was significantly higher than the model control group and the EA control group. Compared with the sham-operation group, the model control group had significant increases in bladder base pressure, maximum pressure, and leak point pressure (P<0.01) and significant reductions in maximum bladder capacity and compliance (P<0.01). Compared with the model control group, the EA group had significant reductions in bladder base pressure, maximum pressure, and leak point pressure (P<0.01) and significant increases in maximum bladder capacity and compliance (P<0.01, P<0.05). Compared with the EA group, the EA control group had significant increases in bladder base pressure, maximum pressure, and leak point pressure (P<0.01) and significant reductions in maximum bladder capacity and compliance (P<0.01, P<0.05). Compared with the sham-operation group, the model control group had significant increases in the protein expression of Wnt-1 and β-catenin (P<0.05, P<0.01) and a signi-ficant reduction in the protein expression of Ngn1 in the spinal cord (P<0.01). Compared with the model control group, the EA group had significant increases in the protein expression of Wnt-1, β-catenin and Ngn1 in the spinal cord (P<0.01). Compared with the EA group, the EA control group had significant reductions in the protein expression of Wnt-1, β-catenin, and Ngn1 in the spinal cord (P<0.01). CONCLUSION: EA at GV14 and BL32 can significantly improve urinary function in rats with bladder DH due to SCT, partially by activating the Wnt/β-catenin signaling pathway and promoting the protein expression of Wnt-1, β-catenin and Ngn1.
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<p><b>OBJECTIVE</b>To discuss the effects on detrusor hyperreflexia treated with ginger-salt-isolated moxibustion at "Shenque" (CV 8) and its mechanism.</p><p><b>METHODS</b>Thirty female adult SD rats were selected. The model of detrusor hyperreflexia was prepared with complete spinal transection at T, of which, 20 rats were randomized into a model group (10 rats) and a moxibustion group (10 rats). A sham-operation group (10 rats) was set up for sham-spinal transection. In the moxibustion group, when urine incontinence occurred (about in 2 weeks of modeling), the ginger-salt-isolated moxibustion at "Shenque" (CV 8) was given, 3 moxa cones each time, once a day, continuously for 7 days. After treatment, in each group, the urodynamic parameters were determined, after which, the bladder detrusor was collected. Western blot was used to determine the protein expressions of M2 and M3 receptors.</p><p><b>RESULTS</b>Compared with the sham-operation group, the micturition interval was shortened apparently (<0.01); the maximal bladder pressure was increased apparently (<0.01); the protein expression of M2 receptor in the detrusor was increased significantly (<0.05) and that of M3 receptor had no apparent change (>0.05) in the rats of the model group. Compared with the model group, the micturition interval was longer apparently (<0.01), the maximal bladder pressure was reduced apparently (<0.01), the protein expression of M2 receptor in the detrusor was reduced significantly (<0.05) and that of M3 receptor had no apparent change (>0.05) in the rats of the moxibustion group.Compared with the sham-operation group, the results of the above indicators were not different significantly in the moxibustion group (all>0.05).</p><p><b>CONCLUSIONS</b>The ginger-salt-isolated moxibustion at "Shenque" (CV 8) suppresses the overactive bladder in the rat with spinal transection and its effect mechanism is possibly relevant with reducing the protein expression of detrusor M2 and inhibiting the excessive contraction of the detrusor.</p>
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@#Objective To observe the effect of electroacupuncture on nerve root of sacral spinal nerve 3 for detrusor hyperreflexia after spinal cord injury. Methods 32 spinal cord injury patients with detrusor hyperreflexia accepted electroacupuncture at sacral 3 nerve root.Their voiding diary, urodynamics and quality of life were observed before and 8 weeks after treatment. Results The frequency of urination,urine leakage, and filling the final detrusor pressure decreased (P<0.05), and the urine output, maximum bladder capacity, bladder compliance,score of quality of life increased (P<0.05) after treatment. There was no significant change in residual urine volume after treatment (P>0.05). Conclusion Electroacupuncture on nerve root of sacral spinal nerve 3 is effective on detrusor hyperreflexia after spinal cord injury.
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Introduction Detrusor hyperactivity is the leading cause of urinary dysfunction in Parkinson's disease (PD). There are few studies correlating PD clinical aspects with this autonomic feature. Methods A cohort of 63 women with PD were prospectively examined for assessment of clinical aspects and disease severity using unified Parkinson's disease rating scale and Hoehn-Yahr scale, respectively. The urologic function was evaluated by the urodynamic study. Two groups were categorized at this time - groups with and without detrusor hyperactivity. After seven years, the same parameters were re-evaluated. Results Progression of the disease on mental scores was found in the group with detrusor hyperactivity. On follow-up, clinical symptoms and severity did not show significant worsening between the groups. Conclusion Detrusor hyperactivity is a frequent urodynamic finding in PD, and even though it is associated with dopaminergic dysfunction, it cannot be blamed as a factor of worsening motor performance, but is probably associated with poor cognitive and mental prognosis. .
Introdução Hiperatividade detrusora (HD) é a principal causa de disfunção urinária na doença de Parkinson e poucos estudos correlacionam aspectos clínicos da doença com este componente autonômico. Métodos Foi avaliada uma coorte de 63 pacientes com DP quanto aos aspectos clínicos e gravidade global da doença utilizando as escalas UPDRS e Hoehn-Yahr. A função urológica foi avaliada através de estudo urodinâmico. Foram então categorizados dois grupos: pacientes com e sem HD. Após sete anos os mesmos parâmetros foram reavaliados. Resultados Houve progressão da doença quanto aos escores mentais no grupo com HD. Na reavaliação dos grupos os sintomas motores não evidenciaram piora significante. Conclusão HD é um achado urodinâmico frequente em pacientes com DP. Embora associada à disfunção dopaminérgica, HD não pode ser considerada fator de risco para piora do desempenho motor, mas provavelmente está associada com pior prognóstico mental e cognitivo. .
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Aged , Aged, 80 and over , Female , Humans , Middle Aged , Psychomotor Performance , Parkinson Disease/complications , Urinary Bladder, Overactive/complications , Urination Disorders/etiology , Cohort Studies , Disease Progression , Prognosis , Prospective Studies , Parkinson Disease/physiopathology , Severity of Illness IndexABSTRACT
@#ObjectiveTo investigate the effects of electroacupuncture in Guanyuan(Ren4) and Zhongji(Ren3) on the functions of neurogenic bladder in patients with spinal cord injury(SCI) with the standard urodynamic measure.Methods15 patients with neurogenic bladder after SCI were included into the study.During urodynamic measure,they accepted electroacupuncture in Guanyuan(Ren4) and Zhongji(Ren3).The changes of the bladder storage volume(VH2O),bladder pressure(Pves),detrusor pressure(Pdet) and bladder compliance(BC) before and after electroacupuncture were recorded.ResultsThe patients' VH2O increased from(124.00±77.37) ml to(144.47±85.87) ml(P<0.01),Pves decreased from(65.33±23.90) cmH2O to(55.27±17.52) cmH2O(P<0.05),Pdet decreased from(52.87±18.68) cmH2O to(44.93±15.82) cmH2O(P<0.05)and BC increased from(2.35±2.05) ml/cmH2O to(3.48±3.04) ml/cmH2O(P<0.01).ConclusionElectroacupuncture is effective on neurogenic bladder recovery in patients with SCI.
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@#ObjectiveTo evaluate the effects of Botulinum toxin type A(BTX-A) repeated injection into detrusor to treat detrusor hyperreflexia and neurogenic incontinence in spinal cord injury(SCI) patients.Methods6 patients with SCI were included into the study.300 U of BTX-A was dissolved in saline 15 ml,and injected into 30 different sites in detrusor using a flexible cystoscopic needle.BTX-A injection was repeated 3 times for all the patients.Urodynamic examination,voiding diary and toxic effects were recorded.ResultsThe improvement for symptoms was observed within 5 to 21 days.The effects of injections lasted averagely 8.9 and 5.8 months for each injection.After the first injection,the mean frequency of incontinence decreased from 10.1 /d to 3.3 /d.The mean volume of intermittent catheterization(IC) increased from 98.5 ml to 404.2 ml each time.Mean cystometric volume increased from 95.4 ml to 385.6 ml,mean maximum storage detrusor pressure decreased from 105.8 cmH2O to 31 cmH2O.After the second injection,the mean frequency of incontinence decreased from 9.7/d to 3.7/d.The mean volume of IC increased from 108.3 ml to 387.2 ml each time.Mean cystometric bladder storage volume increased from 105.4 ml to 375.6 ml.Mean maximum storage detrusor pressure decreased from 97.8 cmH2O to 33 cmH2O.After the third injection,the mean frequency of incontinence decreased from 9.2/d to 3.9/d.The mean volume of IC increased from 115.7 ml to 363.9 ml each time.Mean cystometric volume increased from 102 ml to 357.6 ml.Mean maximum storage detrusor pressure decreased from 98.1 cmH2O to 36.9 cmH2O.The patients were followed up for 6 months.No adverse and toxic effect was observed.ConclusionBotulinum toxin type A repeated injection into detrusor is effective,safe,feasible and mini-invasive to treat detrusor hyperreflexia and neurogenic incontinence in patients with SCI.Botulinum toxin type A repeated injection into detrusor is effective,safe,feasible and mini-invasive to treat detrusor hyperreflexia and neurogenic incontinence in patients with SCI.
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@#ObjectiveTo evaluate the efficacy and tolerance of tolterodine in treating detrusor hyperreflexia in patients with spinal cord injury.Methods50 patients of spinal cord injury patients with detrusor hyperreflexia were involved in this study.The data from voiding diary were evaluated 7 days before and after the patients being treated with tolterodine 2 mg twice daily.ResultsAfter 12 weeks of treatment,the functional bladder volume increased from(114.0±44.3) ml to(207.7±54.9) ml,the mean frequency of micturition decreased from(8.9±2.7) /d to(4.6±2.5) /d,the mean volume of incontinence decreased from(646.7±348.9) ml to(426.6±291.3) ml,the mean frequency of incontinence decreased from(7.8±3.1) /d to(4.8±3.2) /d,which were all statistically different before and after treatment.5 patients felt dry mouth,but they could tolerated it.ConclusionTolterodine is an effective and well tolerable antimuscarinic agent for treating detrusor hyperreflexia after spinal cord injury.
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@#ObjectiveTo evaluate th effect and safety of tolterodine on detrusor hyperreflexia of patients with spinal cord injury.Methods20 cases of spinal cord injury patients with detrusor hyperreflexia were treated with tolterodine (2mg, twice daily), and the data of urodynamics and voiding diary before and after treatment were evaluated.ResultsAfter 12 weeks of treatment, it showed a significant increase from baseline in mean voiding volume (P<0.01), functional bladder volume (P<0.05) and interval of voiding (P<0.01). The bladder volume at first contraction significantly increased from (62.62±36.37)ml to (126.75±34.64)ml (P<0.01), the maximal pressure of detrusor contraction significantly decreased from (74.81±28.60) cm H2O to (61.90±16.22) cm H2O (P<0.05), the maximal amplitude of wave significantly decreased from (47.24±30.42) cm H2O to (39.36±25.28) cm H2O.ConclusionTolterodine is effective and safety to detrusor hyperreflexia of patients with spinal cord injury, and has a better therapeutic compliance and less adverse reactions.
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@#ObjectiveTo observe the efficacy and tolerability of tolterodine on spinal cord injured (SCI) patients with detrusor hyperreflexia.Methods39 cases were treated with tolterodine administration for at least two weeks (8.31±6.47 months in average), the range of drug dosage was 1 mg to 12 mg per day, 5.82±3.13 mg in average. Twelve of them have taken the drug (1-8 mg per day) for one year.ResultsAfter two weeks of treatment, 37 cases (94.87%) had a good effect, and the bladder volume increased 74.36±35.32 ml (P<0.001), the mean frequency of micturition decreased 3.85±2.38 times (P<0.001), urine of each micturition increased 49.74±41.20 ml (P<0.001), the residual urine increased 64.62±41.98 ml(P<0.001).Additionally, hydronephrosis of two cases was remitted. The adverse events: 8 cases of thirsty, 1 case of tachycardia and 1 case of urine retention.ConclusionTolterodine has a good effect and limited side effects on SCI patients with detrusor hyperreflexia.
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OBJECTIVE: This study was purposed to reveal the differences of the findings of pudendal somatosensory evoked potential (PSEP) and electrophysiological bulbocavernosus reflex (EBCR) according to the type of neurogenic bladder. METHOD: The subjects were 65 patients with neurogenic bladder. The causes of neurogenic bladder were consist of seven brain lesions; 39 spinal cord injuries; 15 cauda equina syndromes; and four peripheral polyneuropathies. PSEP and EBCR were done. RESULTS: Of the patients with hyperreflexic bladder (43.1%), PSEP latency was normal in 21.4%, delayed in 21.4%, and not obtainable in 57.2%. Of the patients with areflexic bladder (56.9%), PSEP latency was normal in 24.3%, delayed in 21.6%, and not obtainable in 54.1%. Of the patients with hyperreflexic bladder, EBCR latency was normal in 82.1%, delayed in 14.3%, and not obtainable in 3.6%. Of the patients with areflexic bladder, EBCR latency was normal in 16.2%, delayed in 37.8%, and not obtainable in 46.0% (p<0.01). CONCLUSION: There was significant correlation between EBCR and type of neurogenic bladder, but not with PSEP. These results seem to be reflected from the neuro-anatomical lesion of the neurogenic bladder.
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Humans , Brain , Evoked Potentials, Somatosensory , Polyneuropathies , Polyradiculopathy , Reflex , Spinal Cord Injuries , Urinary Bladder , Urinary Bladder, NeurogenicABSTRACT
Resiniferatoxin, a substance isolated from some species of Euphorbia, a cactus-like plant, shows pharmacological effects similar to those of capsaicin. We administered resiniferatoxin for treating detrusor hyperreflexia to patient with chronic spinal cord injury. Resiniferatoxin solution (100 ml at a concentration of 10-7, 10-6 M) was instilled twice into the bladder of patient with detrusor hyperreflexia and left in place for 30 minutes. Effects on bladder function were monitored at 1 month later follow-up. One month after the last resiniferatoxin instillation, patients reported a significant symptomatic improvement of their incontinence and increased mean bladder capacity.
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Humans , Capsaicin , Euphorbia , Follow-Up Studies , Plants , Reflex, Abnormal , Spinal Cord Injuries , Spinal Cord , Urinary Bladder , Urinary Bladder, NeurogenicABSTRACT
OBJECTIVE: The purpose of this study is to evaluate the patterns of voiding dysfunction of stroke patients during rehabilitation. METHOD: We evaluated 53 patients with complaints of voiding dysfunction following the strokes. After the comprehensive history and physical examination, all patients underwent cystometric study and males underwent the transrectal ultrasound. RESULTS: The incidences of detrusor hyperreflexia, detrusor areflexia, and normal finding on the cystometry were 50.9%, 32.1%, and 17.0%, respectively (p<0.05). There was a significantly high incidence of detrusor hyperreflexia in the groups of subcortical lesion, large lesion, and the over 3 months after stroke (p<0.05). However, there was no statistical difference on cystometric findings according to the other characteristics of the stroke such as the age, sex, type of stroke, cognition, aphasia, and diabetes mellitus. The incidences of irritative, obstructive, and mixed symptoms according to the presenting voiding complaints were 49.1%, 32.1%, and 18.9%, respectively (p<0.05). There was no significant statistical difference on the cystometric findings according to the 3 voiding symptom groups as well as none of significant statistical difference on prostate enlargement in males in according to the 3 voiding symptom groups. CONCLUSION: Only with the pattern of voiding, we could not predict the cystometric finding or the presence of bladder outlet obstruction. Thus, we recommend the further studies including cystometry and evaluation of the bladder outlet obstruction for the treatment of voiding dysfunction of stroke patients during rehabilitation.
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Humans , Male , Aphasia , Cognition , Diabetes Mellitus , Incidence , Physical Examination , Prostate , Reflex, Abnormal , Rehabilitation , Stroke , Ultrasonography , Urinary Bladder Neck ObstructionABSTRACT
OBJECTIVE: To evaluate the effects of botulinum toxin A (BT) dilution volume and post- injection exercise with electrical stimulation on muscle paralysis. METHOD: Eighteen New Zealand white rabbits are randomly assigned to 0.1 ml dilution group, 0.5 ml dilution group or control group. Control group did not receive any injection and 10 units of BT was diluted with 0.1 ml (B1) or 0.5 ml (B5) normal saline and injected to the both gastrocnemius muscles. The right lower limbs of experimental groups did not have any treatment after botulinum toxin A injection (B1C, B5C) and left lower limbs had stretching exercise after injection (B1S, B5S) for 2 hours using the pneumatic kicking machine. Electrical stimulation was also applied to the gastrocnemius muscle with the intensity of 20 mA to 30 mA to evoke plantar flexion of ankle joint. Muscle paralysis effect of BT was evaluated with compound muscle action potential (CMAP) amplitude of gastrocnemius muscle with the sciatic nerve stimulation before and 1 week after injection. RESULTS: There were significant CMAP amplitude decreases in all animals after BT injection. There were significant decreases of CMAP amplitudes in B5 group compared with that of B1 group (p<0.001). Left limbs with stretching exercise and electrical stimulation showed lower CMAP amplitude (p=0.01) compared with right limbs which did not have any treatment after BT injection. CONCLUSION: To maximize muscle paralysis effect of the botulinum toxin A, increasing dilution volume and performing post-injection stretching exercise with electrical stimulation are considered a good strategy.
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Animals , Rabbits , Action Potentials , Ankle Joint , Botulinum Toxins , Electric Stimulation , Extremities , Lower Extremity , Muscle, Skeletal , Muscles , Paralysis , Sciatic Nerve , Stroke , Urinary Bladder Neck ObstructionABSTRACT
Objective To evaluate the effects of Botulinum-A toxin (BTX-A) injection into detrusor to treat detrusor hyperreflexia and neurogenic incontinence in the patients with spinal cord injury (SCI). Methods A total of 31 patients with SCI(mean age,30 years;male 20,female 11) were included into the study.All the patients underwent urodynamic examination and voiding diary was recorded.300 U of BTX-A was dissolved in 15 ml of saline,and the solution of BTX-A was injected into 30 different points in detrusor using a flexible cystoscopic needle.The evaluation for the effects and follow-up included voiding diary,urodynamic testing and observation of adverse and toxic effects. Results After the first injection,29 of the 31 patients had symptom relief within 3 to 14 days;4 cases received the second injection;4 cases were treated in combination with anticholinergic medication;and 2 cases had no improvement and,therefore,received other treatments.The mean follow-up was 8.5 months. After 3-week treatment of BTX-A,the mean frequency of incontinence decreased from 14.2 to 2.5 times per day.The mean volume of intermittent catheterization (IC) increased from 124 to 495 ml each time.Urodynamic data showed that mean cystometric bladder storage volume increased from 133 to 475 ml,mean maximum storage detrusor pressure decreased from 62.7 to 17.1 cmH 2O(1 cmH 2O=0.098 kPa).No adverse and toxic effect was observed. Conclusions Our initial experience suggests that Botulinum-A toxin injection into detrusor to treat detrusor hyperreflexia and neurogenic incontinence in patients with SCI may be an effective,safe,feasible and micro-invasive treatment choice.However,it is necessary to observe its long term outcome.
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PURPOSE: The clinical and urodynamic effects of intravesical capsaicin, a neurotoxic substance causing a reversible suppression of unmyelinated C fiber afferent neuronal activity, were investigated for treatment of detrusor hyperreflexia in patients with spinal cord injury. MATERIALS AND METHODS: Capsaicin solution (2mM) dissolved in 30% alcohol was instilled intravesically in 7 men with detrusor hyperreflexia due to spinal cord injury. Effects on bladder function and subjective symptoms were evaluated before and after intravesical instillation of capsaicin. RESULTS: Bladder function was improved in all but 1 patient. The improvement was expressed as an increase from 108ml to 270ml in maximal bladder capacity and a decrease from 75cmH2O to 44cmH2O in maximal detrusor pressure. Four patients had subjective improvement following treatment and the effects lasted for 4 to 6 weeks. Immediately after capsaicin instillation the ice water test was negative in 2 patients. Autonomic dysreflexia was observed in 4 patients, suprapubic discomfort in 3 patients and gross hematuria in 1 patient. CONCLUSION: Intravesical capsaicin seems to be a promising method for treatment of detrusor hyperreflexia, but the general use of intravesical capsaicin was limited due to side effects.
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Humans , Male , Administration, Intravesical , Autonomic Dysreflexia , Capsaicin , Hematuria , Ice , Nerve Fibers, Unmyelinated , Neurons, Afferent , Reflex, Abnormal , Spinal Cord Injuries , Urinary Bladder , Urodynamics , WaterABSTRACT
Urge incontinence with uninhibited detrusor contraction has been known to be a typical findings observed in the supraspinal neurologic disorders such as cerebrovascular accident(CVA). However, voiding difficulty with significant amounts of residual urine are frequently noted in the patients with organic brain diseases. Also, little is known about the exact causes of voiding difficulty in aged people without obstruction. Herein, Resnik at all have identified a specific physiological abnormality-detrusor hyperreflexia with impaired contractility (DHIC)- a distinct physiological subset of detrusor hyperreflexia. DHIC presents with a seemingly paradoxical set of findings: the bladder is overactive but empties ineffectively. We evaluated the symptoms and urodynamic findings for the 50 patients with supraspinal neuropathies and, also for the 28 elderly peoples complaining voiding dysfunction without evidence of bladder outlet obstruction or, pathologies in the brain. Of the 50 patients with parenchymal brain disease, 41 had CVA, 6 had Parkinson's disease and, 3 had senile dementia. Age of patients ranged from 52 to 89 years and 63 patients of them was man. As a results of urodynamic study; DHIC was noted in 36, DH (detrusor hyperreflexia) in 24, DH with obstructive pattern in 8, ID (impaired detrusor contractility) in 5, normal findings in 5 patients. Of the 36 patients with DHIC, CVA were noted in 19, senile dementia in 1, and, normal aged peoples in 16 cases. In 24 patients with DH, CVA were noted in 9, senile dementia in 1, Parkinson's disease in 6 and, normal aged peoples in 8 cases. Of the 8 patients showed DH with obstruction, CVA was present in 7 and, senile dementia in 1 cases. Of the 5 patients with IDC, CVA was present in 2 and, normal aged peoples in 3 cases. Patients showed DHIC, DH with obstruction and IDC complained obstructive symptoms more frequently than irritative symptoms. On the contrary, DH patients complained irritative symptoms more frequently than obstructive symptoms. Mean fraction of volume voided was 48% in DHIC and 23% in DH with obstruction, which were significantly less than 77% in DH. With this study, hyperreflexic contraction of detrusor was observed in 68(87%), and decreased contractility in 41 patients(53%). The fact that the patients showed DHIC was substantially older than those with DH may imply the decreased contractile function of the detrusor muscle by the aging process. It is also interesting that more than 90% (27/28) of the aged peoples without any pathologies exhibited abnormal findings in urodynamic study explain that the aging process itself may induce the changes of the bladder contractility. Urge incontinence due to DH has been known to be the most common findings in supraspinal lesion. However, these results showed that the impairment of detrusor contractility was also commonly found in the patients with supraspinal lesions and, in aged peoples. Treatment for the DHIC seem to be a dilemma for both the patients and physicians, and it may need emptying of residual urine in addition to the administration of anticholinergics or smooth muscle relaxants.