An Observational Study to Investigate the Association between the Detrusor Muscle Function and the Level of the Spinal Cord Injury

Description

Abstract (English)

Abstract
Aim: The purpose of this study was to investigate the association between the detrusor muscle function and the
level of the spinal cord injury.
Material & Methods: An observational study including 50 patients was conducted in the Department of Urology,
ESICMCH, Bihta, Patna, Bihar, India . Written informed consent was obtained from all participants.
Results: There was a total of 50 individuals with traumatic SCI, of whom 25 (50%) had cervical injury, 12 (24%)
had thoracic injury, 8 (16%) had lumbar injury, and 5 (10%) had sacral vertebral injury. Among these individuals,
29 had neurologically complete injuries and 21 incompletes (according to ASIA) at the time of examination.
All but one cervical patient with DO and detrusor sphincter dyssynergia were negative for sacral cord lesion. Only
one of the 12 patients with thoracic-level injuries had normal urodynamic findings and sacral cord lesion, whereas
none of the patients had detrusor areflexia. None of the 8 patients with lumbar cord injuries with DO and detrusor
sphincter dyssynergia had positive sacral cord lesion, whereas all four patients with detrusor areflexia were
positive for sacral cord lesion. Low bladder compliance was seen in 15 cases with DO, 14 cases with detrusor
sphincter dyssynergia, while in only four cases with detrusor areflexia and one with normal bladder. Most of the
patients with suprasacral cord lesions had high detrusor leak point pressures.
Conclusion: Bladder function differs according to the level of injury. It is, therefore, important to define the
neurological lesion to appreciate the voiding dysfunction and thereby to develop an appropriate management
plan for long-term urologic care. Bladder management should be directed towards protection of upper tracts,
prevention of infection, autonomic dysreflexia, and encouraging bladder emptying at low pressures, as the first
and foremost goal. Despite consistent data regarding classic voiding dysfunction with complete injuries,
multiplicity of injury may contribute to complicated urodynamic findings. Therefore, urodynamic evaluation is
crucial to correctly identify the type of voiding dysfunction and to optimize long-term management.