Neurogenic lower urinary tract dysfunction in association with severity of degenerative spinal diseases: Short-term outcomes of decompression surgery
Neurogenic lower urinary tract dysfunction in association with severity of degenerative spinal diseases: Short-term outcomes of decompression surgery
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DOI：
10.1111/luts.12444
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发表时间：
2022-05-10
影响因子：
1.3
通讯作者：
Ito, Akihiro
中科院分区：
文献类型：
--
作者：
Kimura, Shingo;Takyu, Shunichi;Ito, Akihiro
目的脊髓型颈椎病（CM）和腰椎管狭窄症（LCS）是老年人常见的退行性脊柱疾病，下尿路症状（LUTS）是其主要主诉。本研究的目的是调查接受CM和LCS减压手术的患者的主观和客观泌尿系统参数。方法回顾性分析2010年1月至2011年12月在我院行CM和LCS减压术的患者，术前行国际前列腺症状评分（IPSS）和尿流率测定。排除了可能影响LUTS的合并症患者。对术后1个月内随访的患者进行评估。结果231例LUTS患者在术前接受了评估。92例CM和139例LCS患者中分别有59.8%和64.0%出现中重度泌尿系统症状（IPSS ≥ 8）。26.1%的CM和25.2%的LCS患者的排尿模式较差，定义为最大尿流率> 100 mL。虽然IPSS与疾病严重程度无关，但排尿不良者的日本骨科协会评分更差。此外，差的排尿者由于LCS而遭受骨科症状的时间更长。在随访患者中（CM，n = 32; LCS，n = 47），总IPSS、储存分项评分和排尿分项评分在手术后显著改善，尿流率测定的排尿时间也是如此。结论CM和LCS患者下尿路功能障碍发生率高，减压手术近期疗效好。这些结果将鼓励泌尿科医生考虑骨科咨询时，下尿路功能障碍，确定患者退行性脊柱疾病。
Objectives Cervical myelopathy (CM) and lumbar canal stenosis (LCS) are common degenerative spinal diseases among the elderly, and the major associated complaints include lower urinary tract symptoms (LUTS). The aim of this study was to investigate subjective and objective urological parameters of patients undergoing decompression surgery for CM and LCS. Methods We retrospectively reviewed patients who underwent evaluation by the International Prostate Symptom Score (IPSS) and uroflowmetry before decompression surgery for CM and LCS. Patients with comorbidities that can affect LUTS were excluded. Postoperative changes were evaluated in patients followed up within 1 month. Results Among referrals to urological consultations for LUTS, 231 patients were evaluated preoperatively. Moderate-severe urinary symptoms (IPSS >= 8) were present in 59.8% of 92 CM patients and 64.0% of 139 LCS patients. Poor voiding patterns defined as maximum urinary flow rate 100 mL were identified in 26.1% of CM and 25.2% of LCS. While IPSS did not associate with disease severity, poor voiders presented with worse Japanese Orthopedic Association scores. Moreover, poor voiders suffered for a longer period of time from orthopedic symptoms due to LCS. In followed-up patients (CM, n = 32; LCS, n = 47), total IPSS, storage subscores, and voiding subscores were significantly improved after surgery, as was voiding time from uroflowmetry. Conclusions This study demonstrated high prevalence of lower urinary tract dysfunction of CM and LCS as well as short-term effectiveness of decompression surgery. These results would encourage urologists to consider an orthopedic consultation when lower urinary tract dysfunction is identified in patients with degenerative spinal diseases.