High incidence of occult neurogenic bladder dysfunction in neurologically intact patients with thoracolumbar spinal injuries

Toyohiko Watanabe, Alexander R. Vaccaro, Hiromi Kumon, William C. Welch, David A. Rivas, Michael B. Chancellor

Research output: Contribution to journalArticle

38 Citations (Scopus)

Abstract

Purpose: We determine the relationship between lower urinary tract function and somatic neurological status after thoracolumbar fracture. Materials and Methods: Within 72 hours of thoracolumbar vertebral fracture we evaluated 44 consecutive patients, including 30 men and 14 women 17 to 84 years old (mean age 38.7), with occult neurogenic bladder dysfunction following incomplete thoracolumbar spinal injuries (American Spinal Injury Association impairment classifications C to E). The neurological level and degree of injury were established, and testing for perianal pinprick sensation and bulbocavernosus reflex was done. Video urodynamic evaluation was then performed between 3 and 14 days after injury but before spinal surgery. Results: Urodynamics revealed neurogenic lower urinary tract dysfunction in all 10 patients with classification C, 82% with D and 41% with E (otherwise completely intact neurologically) impairment. Although pinprick sensation deficiency and decreased bulbocavernosus reflex correlated with injury classification, lower urinary tract dysfunction was present in 62% of the patients with intact pinprick sensation and in 59% with intact bulbocavernosus reflex. Conclusions: Neurologically intact patients with thoracolumbar spinal injuries may have neurogenic lower urinary tract dysfunction on urodynamics. Pinprick sensation and bulbocavernosus reflex are specific but not sensitive indicators of lower urinary tract dysfunction after spinal cord injury. Although these indicators, which demonstrate somatic nerve function, were absent in all patients with detrusor areflexia, intact pinprick sensation and bulbocavernosus reflex are not sensitive for predicting lower urinary tract function, which depends on autonomic nerve function. Urodynamic evaluation is mandatory for the complete evaluation of patients with incomplete lumbosacral spinal injuries.

Original languageEnglish
Pages (from-to)965-968
Number of pages4
JournalJournal of Urology
Volume159
Issue number3
DOIs
Publication statusPublished - Mar 1998
Externally publishedYes

Fingerprint

Spinal Injuries
Neurogenic Urinary Bladder
Urinary Tract
Urodynamics
Reflex
Incidence
Autonomic Pathways
Abnormal Reflexes
Wounds and Injuries
Spinal Cord Injuries

Keywords

  • Bladder
  • Neurogenic
  • Spinal cord injuries
  • Spine
  • Urodynamics

ASJC Scopus subject areas

  • Urology

Cite this

High incidence of occult neurogenic bladder dysfunction in neurologically intact patients with thoracolumbar spinal injuries. / Watanabe, Toyohiko; Vaccaro, Alexander R.; Kumon, Hiromi; Welch, William C.; Rivas, David A.; Chancellor, Michael B.

In: Journal of Urology, Vol. 159, No. 3, 03.1998, p. 965-968.

Research output: Contribution to journalArticle

Watanabe, Toyohiko ; Vaccaro, Alexander R. ; Kumon, Hiromi ; Welch, William C. ; Rivas, David A. ; Chancellor, Michael B. / High incidence of occult neurogenic bladder dysfunction in neurologically intact patients with thoracolumbar spinal injuries. In: Journal of Urology. 1998 ; Vol. 159, No. 3. pp. 965-968.
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abstract = "Purpose: We determine the relationship between lower urinary tract function and somatic neurological status after thoracolumbar fracture. Materials and Methods: Within 72 hours of thoracolumbar vertebral fracture we evaluated 44 consecutive patients, including 30 men and 14 women 17 to 84 years old (mean age 38.7), with occult neurogenic bladder dysfunction following incomplete thoracolumbar spinal injuries (American Spinal Injury Association impairment classifications C to E). The neurological level and degree of injury were established, and testing for perianal pinprick sensation and bulbocavernosus reflex was done. Video urodynamic evaluation was then performed between 3 and 14 days after injury but before spinal surgery. Results: Urodynamics revealed neurogenic lower urinary tract dysfunction in all 10 patients with classification C, 82{\%} with D and 41{\%} with E (otherwise completely intact neurologically) impairment. Although pinprick sensation deficiency and decreased bulbocavernosus reflex correlated with injury classification, lower urinary tract dysfunction was present in 62{\%} of the patients with intact pinprick sensation and in 59{\%} with intact bulbocavernosus reflex. Conclusions: Neurologically intact patients with thoracolumbar spinal injuries may have neurogenic lower urinary tract dysfunction on urodynamics. Pinprick sensation and bulbocavernosus reflex are specific but not sensitive indicators of lower urinary tract dysfunction after spinal cord injury. Although these indicators, which demonstrate somatic nerve function, were absent in all patients with detrusor areflexia, intact pinprick sensation and bulbocavernosus reflex are not sensitive for predicting lower urinary tract function, which depends on autonomic nerve function. Urodynamic evaluation is mandatory for the complete evaluation of patients with incomplete lumbosacral spinal injuries.",
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N2 - Purpose: We determine the relationship between lower urinary tract function and somatic neurological status after thoracolumbar fracture. Materials and Methods: Within 72 hours of thoracolumbar vertebral fracture we evaluated 44 consecutive patients, including 30 men and 14 women 17 to 84 years old (mean age 38.7), with occult neurogenic bladder dysfunction following incomplete thoracolumbar spinal injuries (American Spinal Injury Association impairment classifications C to E). The neurological level and degree of injury were established, and testing for perianal pinprick sensation and bulbocavernosus reflex was done. Video urodynamic evaluation was then performed between 3 and 14 days after injury but before spinal surgery. Results: Urodynamics revealed neurogenic lower urinary tract dysfunction in all 10 patients with classification C, 82% with D and 41% with E (otherwise completely intact neurologically) impairment. Although pinprick sensation deficiency and decreased bulbocavernosus reflex correlated with injury classification, lower urinary tract dysfunction was present in 62% of the patients with intact pinprick sensation and in 59% with intact bulbocavernosus reflex. Conclusions: Neurologically intact patients with thoracolumbar spinal injuries may have neurogenic lower urinary tract dysfunction on urodynamics. Pinprick sensation and bulbocavernosus reflex are specific but not sensitive indicators of lower urinary tract dysfunction after spinal cord injury. Although these indicators, which demonstrate somatic nerve function, were absent in all patients with detrusor areflexia, intact pinprick sensation and bulbocavernosus reflex are not sensitive for predicting lower urinary tract function, which depends on autonomic nerve function. Urodynamic evaluation is mandatory for the complete evaluation of patients with incomplete lumbosacral spinal injuries.

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