Lumbosacral evoked potentials and vesicourethral function in patients with chronic suprasacral spinal cord injury

The Video-Urodynamic and Electrophysiological Characteristics in Patients With Traumatic Spinal Cord Injury

Purpose

To investigate the video-urodynamic and pelvic floor electrophysiological characteristics in patients with traumatic spinal cord injury.

Methods

This retrospective reviewed the clinical records, urodynamic and pelvic floor electrophysiological data of 647 patients with traumatic spinal cord injury (SCI) and out of spinal shock. Patients were classified based on American Spinal Injury Association (ASIA) Impairment Scale and urodynamic findings.

Results

Of the 647 patients, detrusor overactivity (DO) with or without detrusor sphincter dyssynergia (DSD) was found in 79.5%, 61%, 35.2%, 35%, and 19.2% of patients with cervical, thoracic (T1-9), thoracic (T10-12), lumbar, and conical cauda injury, respectively. Other patients manifested detrusor areflexia (DA). Patients with DO and/or DSD had a longer duration of SCI at each injury level than patients with DA. In suprasacral injury patients with DA, 63.0% (58/92) had a normal bulbocavernosus reflex (BCR) response. Compared with patients without bladder sensation, bladder capacity during urine leakage was far higher in those with bladder sensation. The manifestation of BCR and somatosensory-evoked potential (SEP) was associated with the level of injury.

Conclusions

This study showed a significant correlation between the level of SCI and video-urodynamic findings, but clinical examination cannot by predict bladder function; urodynamic testing is also necessary. In addition, the role of BCR and SEP for guiding bladder management is limited. Moreover, bladder sensation is important for urinary control in patients with traumatic SCI.

Use of sacral reflex latency measurements in the evaluation of neural function of spinal cord injury patients: a comparison of neuro-urophysiological testing and urodynamic investigations

Complete suprasacral spinal cord injury is followed by great changes in the neural control and function of the lower urinary tract. In the literature there is some controversy about the relationship between detrusor function and results of neurophysiological tests of sacral root conduction after the spinal shock phase. Therefore, we studied this relationship in a group of 73 patients with clinical as well as neurophysiological documented complete suprasacral spinal cord injury, and compared sacral reflex latency measurements (bulbocavernosus and urethro-anal reflexes) with detrusor function, documented by urodynamic investigation. A high incidence of sacral reflex latency abnormalities was found. Comparison of sacral reflex latencies with detrusor reflex activity showed a statistical significant correlation. No such relationship could be found between urodynamic characteristics of the detrusor in patients with detrusor hyperreflexia and sacral reflex latency measurements. We conclude that sacral reflex latency measurements can give an indication about the existence of reflex detrusor activity. On the other hand, these neurophysiological measurements do not provide a reliable indication of the detrusor function after complete spinal cord injury.

Atypical syndromes caudal to the injury site in patients following spinal cord injury. A clinical, neurophysiological and MRI study

Some patients with a cervical or a high thoracic spinal cord injury show atypical signs and symptoms such as atrophy of lower leg muscles, reduced tendon jerks or urinary retention, either persisting from the acute phase or developing in the course of time. A series of 35 patients was prospectively examined from this point of view with neurophysiological, urodynamic and MRI studies. Seven patients (20%) presented atypical findings; in two there was an isolated areflexic bladder, but no signs of functional or structural sacral damage were found. In five patients (14.2%) a definite cause for the sacral lesion could be detected. The syndrome caudal to the level of the lesion is neither obvious at the beginning nor immutable in time. Treatment requires to be adapted to the changing patterns of somatic and visceral activity.