Comparison of urodynamic parameters with respect to neurological levels in post-traumatic spinal cord injury patients

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.

Urethral Pressure Measurement as a Tool for the Urodynamic Diagnosis of Detrusor Sphincter Dyssynergia / 대한배뇨장애요실금학회지

PURPOSE: To describe a technique for urodynamic diagnosis of detrusor sphincter dyssynergia (DSD) using urethral pressure measurements and examine potential associations between urethral pressure and bladder physiology among patients with DSD. METHODS: Multiple sclerosis (MS) and spinal cord injured (SCI) patients with known DSD diagnosed on videourodynamics (via electromyography or voiding cystourethrography) were retrospectively identified. Data from SCI and MS patients with detrusor overactivity (DO) without DSD were abstracted as control group. Urodynamics tracings were reviewed and urethral pressure DSD was defined based on comparison of DSD and control groups. RESULTS: Seventy-two patients with DSD were identified. Sixty-two (86%) had >20 cm H₂O urethral pressure amplitude during detrusor contraction. By comparison, 5 of 23 (22%) of control group had amplitude of >20 cm H₂O during episode of DO. Mean duration of urethral pressure DSD episode was 66 seconds (range, 10–500 seconds) and mean urethral pressure amplitude was 73 cm H₂O (range, 1–256 cm H₂O). Longer (>30 seconds) DSD episodes were significantly associated with male sex (81% vs. 50%, P=0.013) and higher bladder capacity (389 mL vs. 219 mL, P=0.0004). Urethral pressure amplitude measurements during DSD were not associated with significant urodynamic variables or neurologic pathology. CONCLUSIONS: Urethral pressure amplitude of >20 cm H2O during detrusor contraction occurred in 86% of patients with known DSD. Longer DSD episodes were associated with larger bladder capacity. Further studies exploring the relationship between urethral pressure measurements and bladder physiology could phenotype DSD as a measurable variable rather than a categorical observation.

The effect of botulinum toxin injection to the external urethral sphincter on detrusor wall thickness in patients with detrusor-sphincter dyssynergia / 中华物理医学与康复杂志

Objective To evaluate the effect of injecting botulinum toxin A (BTX-A) to the external urethral sphincter on detrusor wall thickness (DWT) and the bladder function of spinal cord injury patients with detrusor-sphincter dyssynergia (DSD).Methods Twenty-one adult patients with DSD due to spinal cord injury were recruited.A single 100 IU dose of botulinum toxin A was injected into their external urethral sphincters via an uhrasound-guided transperineal route.DWT,detrusor leak-point pressure (DLPP),post-void residual volume (PRV) and maximum bladder capacity(MBC) were assessed by urodynamic examination and ultrasound evaluation before and 4 and 8 weeks after the injection.Results Four weeks later a significant decrease in PRV was observed,but no significant difference in DWT,DLPP or MBC.After eight weeks the mean DWT value had decreased by 17％,a significant reduction.There were also significant improvements in DLPP,PRV and MBC at eight weeks compared with the of baseline values.Conclusions BTX-A injection to the external urethral sphincter can reduce DWT and improve bladder function in spinal cord injury patients with DSD.

Urethral stent implantation in treatment for detrusor-sphincter dyssynergia caused by neurogenic lower urinary tract dysfunction / 中国康复理论与实践

@#ObjectiveTo observe the effect of urethral stent implantation on detrusor-sphincter dyssynergia caused by neurogenic lower urinary tract dysfunction.Methods13 patients with detrusor-sphincter dyssynergia caused by neurogenic lower urinary tract dysfunction were treated with the operation of the urethral stent implantation. Voiding function, renal function, residual urine volume and hytronephrosis were examined before and after the operation to evaluate the effect of this procedure.ResultsAfter operation, 7 patients normally emptied their bladders and 6 patients had urinary incontinence. Urethral stents were removed from 2 patients in this group due to the irritation symptoms, the second implantation was performed in a patient due to the voiding difficulty. The renal function of patients after the operation had a non-significant improvement, but the residual urine volume and hytronephrosis improved significantly.Conclusion Urethral stent implantation can decrease residual urine volume and hytronephrosis in patients with detrusor-sphincter dyssynergia caused by neurogenic lower urinary tract dysfunction.

A Usefulness of Pudendal Nerve Block in the Dorsal Approach under EMG Monitoring: A case report

This study was designed to evaluate the usefulness of pudendal nerve block in the dorsal approach under EMG monitoring. The patient is placed in the prone position. The location of pudendal nerve is identified using the both ischial tuberosities and greater trochanter. We have performed the pudenal nerve block with 5% phenol solution, under the EMG monitoring. The patient was able to void with percussion method. There has been no impairment in urinary continence. We experienced an excellent effect of bilateral pudendal nerve block in the dorsal approach, under EMG montoring, using 5% phenol solution in detrusor sphincter dyssynergia of neurogenic bladder.

A Case of Hinman Syndrome Successfully Treated by Non-Surgical Measures

Hinman syndrome is a condition caused by an incoordination between the detrusor and external urethral sphincter during bladder contraction. Manifestations include day-and-night wetting, residual urine, infected urine, vesicoureteral reflux, christmas-tree shaped bladder-wall change, and upper tract damage without neurologic lesion or anatomical obstruction. Recently, this incoordination was postulated to be due to over-compensation of the external sphincter which compensates the uninhibitory detrusor contraction and pathological persistence of this "detrusor-sphincter dyssynergia" habit after brain cortical maturation. Accordingly, this syndrome is an acquired psychosocial-behavioral problem, reversible by bladder training and does not necessitate surgical intervention. We report a case of nonneurogenic neurogenic bladder who was successfully treated by biofeedback training, anticholinergic drugs and intermittent catheterization.

Insertion of Urethral Wallstent (MemothermR) at External Urethral Sphincter for the Treatment of Patients with Complicated Detrusor Sphincter Dyssynergia / 대한비뇨기과학회지

In patients with spinal cord injury, detrusor sphincter dyssynergia is a common and troublesome problem that may evoke progressive deterioration of upper urinary tract and urinary tract infection including sepsis. Instead of external sphincterotomy, urethral wallstent may be the useful treatment for the patients with detrusor sphincter dyssynergia refractory to conventional treatment. In addition, this method has some advantages of less invassive, less morbid and simpler technique than other treatment methods. We report our preliminary results of the urethral wallstent(MemothermR) for the treatment of 2 patients with complicated detrusor sphincter dyssynergia.