Errors of Rectal Pressure Measurement in Urodynamic Study of Spinal Cord Injured Patients

OBJECTIVE: The intrarectal pressure can make error during urodynamic study and can decrease the accuracy of detrusor pressures. The purpose of this study was to investigate the incidence and cause of the error in measurement of recral pressure. METHOD: Forty-eight patients with spinal cord injury were enrolled. With the patients in the lithotomy position, catheter was placed into the bladder and the rectum, then urodynamic testing began by infusion of normal saline (20~30degrees C) via urethral catheter. The errors by measurement of rectal pressure during urodynamic study were recorded. According to the position of patients and spasticity of hip flexors, difference of rectal pressure was investigated. RESULTS: The error rate of intrarectal pressure during urodynamic study was 41%. Intrarectal pressure was higher in lithotomy position than in lateral lying position. According to modified Ashworth scale of hip flexors, intrarectal pressure in grade 0 was significantly lower than grade 1, 1.5 and 2 (p<0.05). CONCLUSION: There was significant errors in measuring of the intravesical pressure during urodynamic study. These factors might be posture, spasticity of hip flexors, and expelling of the catheter in urodynamic study.

Change of Intra-abdominal Pressure on Daily Activities in Patients with Spinal Cord Injury

PURPOSE: To evaluate the change of intra-abdominal pressure related with intravesical and intrarectal pressure in patients with spinal cord injury according to daily activities and postural changes which make the abdominal pressure elevated. MATERIALS AND METHODS: Ten subjects with lower thoracic and lumbar spinal cord injury were enrolled. Their mean age was 38 years. The urodynamic study was performed and the intravesical and the intrarectal pressures were measured with a double lumen catheter and a intrarectal probe. The intravesical and the intrarectal pressure were obtained during patient's speech, sneeze, cough, valsalva and various postural changes with supine to decuitus, decubitus to supine, supine to sit, and sit to supine according to empty and full bladders, respectively. RESULTS: The order of higher intravesical and intrarectal pressure rise during various maneuvers were valsalva, sneeze, supine to sit and cough, respectively. Higher correlation coefficient between the intravesical and intrarectal pressures were noted during cough, sneeze, valsalva and supine to sit in empty bladder than full one. CONCLUSION: These results demonstrated that the intravesical and intrarectal pressures were influenced by daily activities and postural changes of increasing the intra-abdominal pressure. The intrarectal pressures according to daily activities such as cough, sneeze, valsalva and postural change were significantly related with intravesical pressures.