BLADDER AND SPHINCTER BEHAVIOR IN PATIENTS WITH SPINAL-CORD LESIONS
BLADDER AND SPHINCTER BEHAVIOR IN PATIENTS WITH SPINAL-CORD LESIONS
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DOI：
10.1016/s0022-5347(17)37727-3
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发表时间：
1991-07-01
影响因子：
6.6
通讯作者：
BLAIVAS, JG
中科院分区：
文献类型：
--
作者：
KAPLAN, SA;CHANCELLOR, MB;BLAIVAS, JG
为了明确临床神经水平与膀胱和括约肌行为之间的关系，回顾性分析了489例各种原因所致脊髓病变患者的视频尿动力学研究。 根据临床神经学水平、病变病因和是否存在骶髓受累体征对患者进行分类。 尿动力学检查结果分为逼尿肌反射亢进、逼尿肌-外括约肌协同失调、逼尿肌无反射或正常。 结果表明，虽然有一个一般的相关性神经损伤的水平和预期的膀胱尿道功能，它既不是绝对的，也不是特定的。 例如，117例颈髓病变中有20例有逼尿肌无反射，156例腰髓病变中有42例有逼尿肌-外括约肌协同失调，84例骶髓病变中有26例有逼尿肌反射亢进或逼尿肌-外括约肌协同失调。 然而，如果考虑到存在神经系统异常，84%的骶上脊髓病变伴逼尿肌无反射有骶脊髓征。 相反，所有骶上脊髓病变没有证据表明骶髓受累，逼尿肌反射亢进或逼尿肌-外括约肌协同失调。 骶索征阳性和逼尿肌无反射的阳性预测值为87%。 阴性骶索征和逼尿肌反射亢进/逼尿肌-外括约肌协同失调的阳性预测值为81%。 这些数据表明，单独的临床神经系统检查是不够的晴雨表，预测神经泌尿功能障碍，视频尿动力学评价提供了一个更准确的诊断为每个病人。
To ascertain the relationship between the clinical neurological level, and bladder and sphincter behavior, the video-urodynamic studies of 489 patients with spinal cord lesions due to a variety of causes were retrospectively analyzed. Patients were classified based on the clinical neurological level, etiology of the lesion and presence or absence of signs of sacral cord involvement. Urodynamic findings were classified as either detrusor hyperreflexia, detrusor-external sphincter dyssynergia, detrusor areflexia or normal. The results indicate that although there was a general correlation between the neurological level of injury and the expected vesicourethral function, it was neither absolute nor specific. For example, 20 of 117 cervical cord lesions had detrusor areflexia, 42 of 156 lumbar cord lesions had detrusor-external sphincter dyssynergia and 26 of 84 sacral cord had either detrusor hyperreflexia or detrusor-external sphincter dyssynergia. However, if one considers the presence of neurological abnormalities, 84% of the suprasacral cord lesions with detrusor areflexia have sacral cord signs. In contrast, all suprasacral cord lesions with no evidence of sacral cord involvement have either detrusor hyperreflexia or detrusor-external sphincter dyssynergia. The positive predictive value for positive sacral cord signs and detrusor areflexia was 87%. The positive predictive value for negative sacral cord signs and detrusor hyperreflexia/detrusor-external sphincter dyssynergia was 81%. These data suggest that the clinical neurological examination alone is not an adequate barometer to predict neurourological dysfunction and that video-urodynamic evaluation provides a more precise diagnosis for each patient.