[Analysis for related factors of upper urinary tract deterioration in patients with spinal cord injury].

OBJECTIVE: To evaluate the related factors of upper urinary tract deterioration in spinal cord injured patients. METHODS: Medical records of spinal cord injured patients from Jan.2002 to Sep.2009 were retrospectively reviewed. All the patients were divided into the upper urinary tract deterioration group and non-deterioration group according to the diagnostic criteria. Indexes such as demographic characteristic (gender, age), spinal cord injury information (cause, level, completeness), statuses of urinary tract system (bladder management, urine routine, urine culture, ultrasound, serum creatinine, fever caused by urinary tract infection) and urodynamics information(bladder compliance, bladder stability, bladder sensation, detrusor sphincter dyssynergia, detrusor leak point pressure, maximum cystometric capacity, relative safe bladder capacity, maximum flow rate, maximum urethra closure pressure) were compared between the two groups.Then Logistic regression analysis were performed. RESULTS: There was significantly difference between the two groups in spinal cord injury level(χ(2) = 8.840, P = 0.031),bladder management(χ(2) = 11.362, P = 0.045), urinary rutine(χ(2) = 17.983, P = 0.000), fever caused by urinary tract infection(χ(2)= 64.472, P = 0.000), bladder compliance(χ(2) = 6.531, P = 0.011), bladder sensation(χ(2) = 11.505, P = 0.009), maximum cystometric capacity(t = 2.209, P = 0.043), and detrusor-sphincter dyssynergia(χ(2) = 4.247, P = 0.039). The multiple-factor non-conditional Logistic regression analysis showed that bladder management (OR = 1.114, P = 0.006), fever caused by urinary tract infection(OR = 1.018,P = 0.000), bladder compliance (OR = 1.588, P = 0.040) and detrusor-sphincter dyssynergia(OR = 1.023, P = 0.034) were the key factors of upper urinary tract deterioration in spinal cord injured patients. CONCLUSION: Urinary tract infection, lower bladder compliance, detrusor-sphincter dyssynergia and unreasonable bladder management are the risk factors of upper urinary tract deterioration in spinal cord injured patients.

[Video-urodynamic characteristics and management in complete cervical and thoracic spinal cord injury patients].

OBJECTIVE: To explore the video-urodynamic characteristics and management in complete cervical and thoracic spinal cord injury patients. METHODS: Video-urodynamic examination was performed in 113 patients with complete cervical and thoracic spinal cord injury from January 2008 to May 2010. And their characteristics, managements and 3-year follow-up outcomes were reviewed and analyzed retrospectively. RESULTS: Among them, there were detrusor overactivity (n = 82, 72.57%), detrusor areflexia (n = 31, 27.43%), detrusor external sphincter dyssynergia (n = 71, 62.83%), low-compliance (n = 59, 52.21%), reflux (n = 6, 5.31%) and ultrasonic uronephrosis (n = 12, 10.62%). According to the result of the video-urodynamic examination, detrusor overactivity patients chose oral anticholinergic agents, botulinum toxin type A injection method, detrusor areflexia patients chose regular intermittent catheterization for bladder training. During a 3-year follow-up, there were cystic calculus (n = 2) and urinary infection (n = 7).No special complication occurred. CONCLUSIONS: The video-urodynamic characteristics vary in complete cervical and thoracic spinal cord injury patients. The major symptoms include detrusor overactivity, detrusor external sphincter dyssynergia and low-compliance bladder. Proper management is essential for protecting upper urinary tract and preventing urinary system complication.

[Clinical observation of holmium laser enucleation of the prostate in the treatment of benign prostatic hyperplasia and overactive bladder].

OBJECTIVE: To evaluate clinical efficacy of holmium laser enucleation of the prostate in the treatment of benign prostatic hyperplasia (BPH) and overactive bladder (OAB). METHODS: From May 2007 to May 2010, a total of 37 patients diagnosed BPH and OAB were treated by holmium laser enucleation of the prostate. After a mean follow-up of 4.9 months postoperatively, indices such as International Prostate Symptom Score (IPSS), quality of life (QOL) score, maximum flow rate (Qmax), residual urine volume and video urodynamics were monitored and statistically analyzed. RESULTS: The mean preoperative IPSS and QOL score were 29.6 ± 5.2 and 4.3 ± 0.9, and decreased to 4.6 ± 1.2 and 1.2 ± 1.0 postoperative. The mean Qmax was (6 ± 3) ml/s preoperative and increased to (21 ± 5) ml/s postoperative. Preoperative average residual urine volume was (167 ± 11) ml, decreased to (41 ± 18) ml after operation. During follow-up, 86.5% patients' symptoms and quality of life improved continuously, however 13.5% patients existed residual postoperative OAB symptoms. CONCLUSIONS: When BPH with OAB patients exist bladder outlet obstruction, bladder outlet obstruction should be relieved first then OAB symptoms can be relieved in majority of patients, but some patients have residual symptoms.

[Neuromodulation for treatment for neurogenic bowel dysfunction].

OBJECTIVE: To explore the efficacy of neuromodulation (including sacral neuromodulation and dorsal penile/clitoral nerve neuromodulation) for the treatment to neurogenic bowel dysfunction due to spinal cord injury. METHODS: From January 2006 to April 2008, 9 patients with neurogenic constipation after spinal cord injury underwent the therapy of neuromodulation, 1 patient underwent the therapy of sacral neuromodulation, 8 patients underwent the therapy of dorsal penile/clitoral nerve neuromodulation. The therapeutic efficacy was evaluated and followed up by means of Wexner constipation score. RESULTS: One patient received permanent electrode and neurostimulator implantation and constipation were improved continuously. A significant improvement in the Wexner constipation score was observed compared with the preoperative baseline level (preoperative baseline: median 22; after implantation: median 9). Four patients were effective after the therapy of dorsal penile/clitoral nerve neuromodulation. Wexner constipation score decrease from 19 to 11 after 12 weeks dorsal penile/clitoral nerve neuromodulation. Patients also showed a significant improvement in their symptoms and quality of life during follow up. CONCLUSIONS: Sacral neuromodulation and dorsal penile/clitoral nerve neuromodulation may be effective for some neurogenic constipation. However there are no methods successfully identify the candidate who will be beneficial before the procedure. Good quality research data are needed to evaluate the effects of sacral neuromodulation and dorsal penile/clitoral nerve neuromodulation for these conditions.

[Video-urodynamic studies on 1800 patients with neurogenic bladder].

OBJECTIVE: To explore the Video-urodynamic characteristics of various neurogenic bladder. METHODS: A total of 1800 patients with neurogenic bladder were included in our study from December 2002 to June 2008. All patients underwent Video-urodynamic studies. Urodynamic data was collected and analyzed. RESULTS: Urodynamic study showed detrusor overactivity in 71%, of which 60% with uninhibited sphincter relaxation, and acontractile detrusor in 29% stroke patients. No upper urinary tract deterioration was found in all 42 stroke patients. Detrusor overactivity without sphincter dyssynergia was found in 70% patients with head trauma. Seven patients with Parkinson disease showed detrusor overactivity, of which 3 with delayed sphincter relaxation. Detrusor overactivity was found in 91% and detrusor sphincter dyssynergia in 83% supra-sacral spinal cord injured patients. Acontractile detrusor was found in 73% patients with conus medullaris and cauda equina injury. Overall, upper urinary tract changes were found in 12% and vesicoureteral reflux in 4% spinal cord injured patients. Urodynamic study showed acontractile detrusor in 81%, reduced compliance in 86%, upper urinary tract changes in 55% and vesicoureteral reflux in 33% patients with myelodysplasia. Most patients (92%) with protruded lumbar disc showed detrusor areflexia. Normal bladder compliance was found in 88% patients with protruded lumbar disc. Urodynamic study showed reduced bladder sensation in 81% and detrusor under-activity in 76% patients with diabetic urinary bladder disease. CONCLUSIONS: Video-urodynamic study can provide the most detailed information about the bladder dysfunction. It is the most valuable examination before treatment of patients with neurogenic bladder.

Electrical stimulation of dog pudendal nerve regulates the excitatory pudendal-to-bladder reflex.

Pudendal nerve plays an important role in urine storage and voiding. Our hypothesis is that a neuroprosthetic device placed in the pudendal nerve trunk can modulate bladder function after suprasacral spinal cord injury. We had confirmed the inhibitory pudendal-to-bladder reflex by stimulating either the branch or the trunk of the pudendal nerve. This study explored the excitatory pudendal-to-bladder reflex in beagle dogs, with intact or injured spinal cord, by electrical stimulation of the pudendal nerve trunk. The optimal stimulation frequency was approximately 15-25 Hz. This excitatory effect was dependent to some extent on the bladder volume. We conclude that stimulation of the pudendal nerve trunk is a promising method to modulate bladder function.