Evaluation of bladder functions in chronic spinal injuries

Fifty patients with spinal cord injuries of two years duration were submitted to clinical, neurological and urodynamic evaluation. Neurogenic incontinence was the main presenting feature in most of cases 45 [90%]. However, difficulty and retention of urine were found in only 5 cases [10%]. The eventual picture of spinal cord injury depends on the level, duration and the extent of the lesion. These consecutively studied cases were having chronic and established lesions in most of the cases. From the clinical point of view, 30 cases out of 50 were clinically categorized as either having UMNL [16 cases], or LMNL [14 cases]. The remaining 20 cases, showed clinically a picture of mixed upper and LMNL. Therefore, urodynamic assessment was mandatory to clarify the eventual effect on the bladder function. By the virtue of urodynamis, it was possible to categorize the patients into hyperreflexic [30 cases] and areflexic [20 cases]. Urographic evaluation of these cases enabled us to study the state of the bladder which was decompensated in more than 50% of cases of areflexia and only in 10% of hyperreflexic cases. Again; refluxing ureter and deterioration of renal function were also detected. The incidence of reflux was more in the group of hyperreflexia [33%] compaired to - 20% in the areflexic group. The presence of high pressure reflux in cases of hyperreflexia was supported by presence of U.D.C and high urethral closing pressure in this group, detected by UPP