Urological Disturbances in Patients with the Spinal Dural Arteriovenous Fistulas
Creators
- 1. SI «Research and Practical Center for Endovascular Neuroradiology of the National Academy of Medical Sciences of Ukraine», Ukraine
Description
Spinal dural arteriovenous fistulas (SDAVFs) are the most common vascular malformation of the spinal cord. However, they remain an undiagnosed pathology and, in case of untimely treatment cause significant disability. SDAVFs can debut with urination disorders, erectile dysfunction, and mimic different pathologies. At the same time, the vast majority of cases are difficult to diagnose. The urological aspects of SDAVFs are important for proper evaluation and management of patients with urological disorders.
The objective: to analyze the urological disorders in patients with spinal dural arteriovenous fistulas and their course after surgical treatment.
Materials and methods. From June 2009 to January 2023, 67 patients with arteriovenous malformations of the spinal cord were surgically treated at the SI «Research and Practical Center for Endovascular Neuroradiology of the National Academy of Medical Sciences of Ukraine». 44 (65.7%) patients were diagnosed with SDAVFs (arteriovenous malformations of the spinal cord type I according to Anson–Spetzler). Among the studied group were 30 (68.2%) men and 14 (31.8%) women aged 32–67 years (average age – 59.6 years).
Treatment options for SDAVFs included endovascular embolization, microsurgical debridement, or their combination. A modified Aminoff–Logue scale was used to compare clinical results before and after treatment.
After treatment, patients were divided into three categories: patient’s condition was improved, patient’s condition remained unchanged, or worsened.
Results. As a result of the study, it was established that SDAVFs of the cervical spine was diagnosed in 6 (13.6%) patients, thoracic one – in 20 (61.9%), lumbar – 15 (21.1%), and sacrum – 3 (6.8%).
The main initial symptoms of SDAVFs were gait disturbances, sensory disturbances, and paresthesias. The most common symptoms at the time of the final diagnosis were urination disorders in 36 (81.8%) patients, paraparesis – in 37 (84.1%), sensitivity disorders – in 30 (68.1%), defecation problems – in 17 (38.6%), pain in the back and legs – in 21 (47.8%) patients, erectile dysfunction – in 11 (25.0%) patients.
After the total separation of the fistula, a favorable clinical result was observed in 31 (93.9%) of 33 patients. Improvement of urinary problems and erectile dysfunction was determined in 19 (52.7%) patients. Residual symptoms were found in 17 (47.3%) patients.
Conclusions. Early intervention and elimination of pathologic arteriovenous shunting is necessary for neurological improvement in patients with SDAVFs, but urination disorders persist in half of patients even after successful treatment.
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References
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