Neurol Sci DOI 10.1007/s10072-014-1792-7
ORIGINAL ARTICLE
Protective effect of preserved bladder-filling sensation on upper urinary tract in patients with spinal cord injury Murat Erso¨z • Selc¸uk Sayılır
Received: 19 February 2014 / Accepted: 3 April 2014 Ó Springer-Verlag Italia 2014
Abstract In this study the possible preventive effect of bladder-filling sensation (BFS) on upper urinary tract deterioration (UUTD) in spinal cord injury (SCI) patients was investigated. Eighty-four (60 males, 24 females) patients with SCI who underwent neurourological assessment and urodynamic examinations because of neurogenic lower urinary tract dysfunction and were prescribed appropriate bladder management and were under follow-up and whose disease duration was at least 3 years were included in the study. Bladder-filling sensation was categorised as ‘‘absent’’, ‘‘partially preserved’’ or ‘‘preserved’’, and as ‘‘normal’’ (preserved) and ‘‘abnormal’’ (partially preserved, absent). Presence of hydronephrosis, renal stones, and chronic pyelonephritis in any renal USG or IVP performed during the follow-up period were accepted as criteria of UUTD. The frequencies of UUTD for BFS subgroups were determined and compared. Mean age and mean disease duration were 38.4 ± 13.0 years and 72.2 ± 36.2 months. The frequency of UUTD was 31/84 (36.9 %) in the study population. The frequencies of UUTD were 0/8 (0 %), 22/53 (41.5 %) and 9/23 (39.1 %) for ‘‘preserved’’ ‘‘partially preserved’’ and ‘‘absent’’ BFS subgroups, respectively (p = 0.074). There was a statistically significant difference between normal BFS [0/8 (0 %)] and abnormal BFS [31/76 (40.8 %)] subgroups
M. Erso¨z Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Yıldırım Beyazıt University, Ankara, Turkey M. Erso¨z (&) S. Sayılır Ankara Physical Medicine and Rehabilitation Training and Research Hospital of Ministry of Health, Ankara, Turkey e-mail: [email protected]
(p = 0.024). According to the results of our study preserved (normal) bladder-filling sensation has protective effect on upper urinary tract in patients with SCI. Keywords Spinal cord injury Bladder-filling sensation Upper urinary tract deterioration
Introduction Neurogenic lower urinary tract dysfunction (NLUTD) is common in patients with spinal cord injury (SCI) and can cause significant morbidity and reduce quality of life [1]. Assessment and management of NLUTD are mandatory in patients with SCI for prevention of upper urinary tract deterioration (UUTD). Evaluation of bladder-filling sensation during urodynamic studies, which guides daily urinary behaviour is important. Preservation of bladder-filling sensation (BFS) in some of the patients with spinal cord injury has been reported previously [2–8]. Although awareness of the sensations from bladder theoretically may help prevention of urinary tract, there is no specific study focused on the possible protective function of BFS on urinary tract. The aim of this study was investigation of possible preventive effect of bladder-filling sensation on upper urinary tract damage in SCI patients.
Materials and methods Eighty-four (60 male, 24 female) adult patients with SCI who underwent neurourological assessment and urodynamic examinations because of neurogenic lower urinary tract dysfunction and were provided appropriate bladder management and were under follow-up and whose disease
123
Neurol Sci
duration was at least 3 years were included in the study. The patients with normal basic urinary system tests including renal USG and IVP were enrolled in the study. The urodynamic reports of the patients were analysed retrospectively using the urodynamics laboratory records between 2002 and 2013. The age, gender, etiologic factor, disease duration, SCI level and class according to American Spinal Injury Association (ASIA) Impairment Scale (AIS) classification of the patients were recorded. Presence of hydronephrosis, renal stones and chronic pyelonephritis in any renal USG or IVP performed during the follow-up period were accepted as criteria of UUTD in patients whose basic urinary system tests including renal USG and IVP were normal [9]. Urodynamic investigations were performed by the same investigator (first author) using a Libra ? (MMS, Enschede, The Netherlands) urodynamic measurement system. Each patient was positioned supine on a urological table. An 8 Fr 2-lumen catheter for patients were introduced transurethrally for bladder filling. The bladder was emptied. Continuous medium fill cystometry was performed at 50 ml/min with room temperature sterile saline. Blood pressure was monitored during the cystometric examinations, and signs or symptoms of autonomic dysreflexia (AD) were monitored. The patients were informed about the bladder-filling sensations (first sensation of bladder filling, first desire to void and strong desire to void) before the investigation and were asked to report all sensations related to bladder filling, but not to report anything if they do not feel anything [11, 12]. Filling was terminated when the patient had a strong desire to void, when intravesical pressure reached 40 cm H2O or when significant leakage or symptoms of AD and blood pressure changes (systolic blood pressure higher than 140 or 20–40 mmHg increase in the systolic blood pressure [12]) occured. The BFS was categorised as ‘‘absent’’, ‘‘partially preserved’’ (different in quality or magnitude) and ‘‘preserved’’ (same as it was before the trauma) [5]. Then the frequencies of patients in BFS subgroups and UUTD frequencies in each BFS subgroup were determined. Upper urinary tract deterioration frequencies in normal (preserved) and abnormal (partially preserved, absent) BFS subgroups and in complete (AIS A) and incomplete (AIS B–E) SCI subgroups were also determined. The SPSS software Version 15.0 was used for data analysis. The data were expressed as the mean and standard deviation, as median or as frequencies when appropriate. p \ 0.05 was considered as statistically significant. The frequencies of UUTD for BFS subgroups, normal and abnormal BFS subgroups and complete and incomplete SCI subgroups were determined and compared by Chi square test or Fischer’s exact test when appropriate.
123
Table 1 Demographic and clinical features of the patients (n = 84) Mean age (years)
38.4 ± 13.0 (median = 36, range 18–71)
Disease duration (months)
72.2 ± 36.2 (median = 58, range 32–216)
Gender (female/male)
24 (28.6 %)/60 (71.4 %)
Level of lesion (cervical/thoracic/ lumbosacral)
16 (19.0 %)/51 (60.7 %)/17 (20.2 %)
AIS class (A/B/C/D/E)
53 (63.1 %)/14 (16.7 %)/10 (11.9 %)/7 (8.3 %)/0
Etiologic factors (vehicle accident/ fall/gun shot/diving/crushed)
31 (38.8 %)/34 (42.5 %)/4 (5.0 %)/3 (3.8 %)/8 (10.0 %)
Table 2 Bladder-filling sensation category frequencies in the study population and in incomplete and complete spinal cord injury subgroups Bladder-filling sensation frequency Preserved (%)
Partially preserved (%)
Absent (%)
All patients (n = 84)
8 (9.5)
53 (63.1)
23 (27.4)
Incomplete spinal cord injury (n = 31)
8 (25.8)
22 (71.0)
1 (3.2)
Complete spinal cord injury (n = 53)
0 (0)
31 (58.5)
22 (41.5)
Results Mean age and mean disease duration were 38.4 ± 13.0 (median = 36, range 18–71) years and 72.2 ± 36.2 (median = 58, range 32–216) months. Sixteen patients had cervical, 51 had thoracic and 17 had lumbosacral lesions. AIS classes were A in 53, B in 14, C in 10 and D in 7 patients. Demographic and clinical data of the patients are presented in Table 1. Bladder-filling sensation category frequencies in the study population and in incomplete and complete SCI subgroups are shown in Table 2. All the patients with preserved BFS were in the incomplete SCI group (3 AIS B, 3 AIS C, 2 AIS D). The frequency of UUTD was 31/84 (36.9 %) in the study population. The frequencies of UUTD for BFS subgroups are given in Table 3. The frequencies of UUTD were 0/8 (0 %), 22/53 (41.5 %) and 9/23 (39.1 %) for ‘‘preserved’’ ‘‘partially preserved’’ and ‘‘absent’’ BFS subgroups, respectively. There was no statistically significant difference between subgroups in Chi square test (p = 0.074). There was a statistically significant difference between normal BFS [0/8 (0 %)] and abnormal BFS [31/76 (40.8 %)] subgroups (p = 0.024). No statistically significant difference was observed between complete (AIS A)
Neurol Sci Table 3 Frequencies of upper urinary tract damage in bladder-filling sensation subgroups Bladder-filling sensation category Preserved
Upper urinary tract damage frequency (%) 0/8 (0)
Partially preserved
22/53 (41.5)
Absent Normal (preserved)
9/23 (39.1) 0/8 (0)
Abnormal (partially preserved, absent)
31/76 (40.8)
p
0.074
0.024
[23/53, (43.4 %)] and incomplete (AIS B–E) [8/31 (25.8 %)] SCI subgroups with respect to UUTD frequency (p [ 0.05).
Discussion Bladder-filling sensation which guides daily urinary behaviour in healthy subjects is a very important component of urinary function. An individual with normal BFS by the continuous sensorial inputs from the lower urinary tract can determine when to empty his or her bladder and can prevent his or her urinary tract from the destructive effects of overdistention. Furthermore, he or she can look for appropriate treatment in pathological conditions of the urinary tract like any obstruction in urinary tract, urinary tract infections, etc. by the help of the unpleasent sensations originated from these pathological conditions. In all these situations BFS theoretically appears as a protective function on urinary tract. Observation of high rates of upper urinary tract damage reaching 43 % in early SCI series is in accordance with this forementioned assumption as absence or severe deficits of BFS are frequent in this patient group [13–16]. However, no study has investigated the possible protective function of BFS on urinary tract in patients with SCI. We think that the statistically significant lower rate of UUTD in SCI patients with normal (preserved) BFS in comparison with abnormal BFS subgroups we observed in our study supports this assumption. Similar UUTD frequencies observed in partially preserved and absent BFS subgroups revealed that partially preserved BFS is not protective for UUTD. An important point to mention here is the distribution of the patients with preserved BFS in SCI lesion groups. All the patients with preserved BFS were in the incomplete SCI group (3 AIS B, 3 AIS C, 2 AIS D). Similar findings have been reported previously [5]. Although preserved BFS patients appeared as a subgroup of incomplete SCI group incompleteness of the SCI did not appear as a protective feature on urinary tract in our study. In a recent
study no statistically significant difference between complete and incomplete SCI patients in terms of upper urinary tract USG findings has been reported which was in accordance with our study results [9]. We feel that our study results further emphasized the importance of bladder-filling sensation investigations during urodynamic studies in SCI patients. Knowing the protective effect of preserved (normal) BFS on urinary tract in SCI patients and knowing the absence of this protective effect in partially preserved and absent BFS subgroups will help the physician during making more accurate therapuetic decisions in daily practice. However, all the patients with SCI including the ones with preserved BFS should be followed up strictly for prevention of any undesirable manifestations of the NLUTD. New prospective studies with larger sample sizes may help increasing our knowledge about the protective effect of BFS. In conclusion, we can say that preserved bladder-filling sensation has protective effect on upper urinary tract in patients with SCI. Bladder-filling sensation investigations should be carried out in SCI patients during urodynamic studies. Although preserved BFS appeared as a protective feature in SCI patients, the possibility of occurrence of UUTD should be kept in mind and appropriate and continuous management of the NLUTD should be carried out even in those patients with preserved BFS.
References 1. Whiteneck GG, Charlifue SW, Frankel HL, Fraser MH, Gardner BP, Gerhart KA et al (1992) Mortality, morbidity, and psychosocial outcomes of persons spinal cord injured more than 20 years ago. Paraplegia 30:617–630 2. Pavlakis AJ, Siroky MB, Goldstein I, Krane RJ (1983) Neurourologic findings in conus medullaris and cauda equina injury. Arch Neurol 40:570–573 3. Wyndaele JJ (1991) Investigation of the afferent nerves of the lower urinary tract in patients with ‘complete’ and ‘incomplete’ spinal cord injury. Paraplegia 29:490–494 4. Wyndaele JJ (1997) Correlation between clinical neurological data and urodynamic function in spinal cord injured patients. Spinal Cord 35:213–216 5. Ersoz M, Akyuz M (2004) Bladder-filling sensation in patients with spinal cord injury and the potential for sensation-dependent bladder emptying. Spinal Cord 42:110–116 6. Reitz A (2012) Afferent pathways arising from the lower urinary tract after complete spinal cord injury or cauda equina lesion: clinical observations with neurophysiological implications. Urol Int 89:462–467 7. Shin JC, Chang WH, Jung TH, Yoo JH, Park SN (2008) The determination of sensation-dependent bladder emptying time in patients with complete spinal cord injury above T11. Spinal Cord 46:210–215 8. Sayılır S, Erso¨z M, Yalc¸ın S (2013) Comparison of urodynamic findings in patients with upper and lower cervical spinal cord injury. Spinal Cord 51:780–783
123
Neurol Sci 9. Akkoc Y, Cinar Y, Kismali E (2012) Should complete and incomplete spinal cord injury patients receive the same attention in urodynamic evaluations and ultrasonography examinations of the upper urinary tract? Int J Rehabil Res 35:178–180 10. Wyndaele JJ (1998) The normal pattern of perception of bladder filling during cystometry studied in 38 young healthy volunteers. J Urol 160:479–481 11. Wyndaele JJ, Wachter SD (2002) Cystometrical sensory data from a normal population: comparison of two groups of young healthy volunteers examined with 5 years interval. Eur Urol 42:34–38 12. Consortium for spinal cord medicine (2006) Bladder management for adults with spinal cord injury: a clinical practice guideline for health-care providers. ISBN: 0-929819-19-5
123
13. Burke DC (1974) Traumatic spinal paralysis in children. Paraplegia 11:268–276 14. Fanciullacci F, Zanollo A, Sandri S, Catanzaro F (1988) The neuropathic bladder in children with spinal cord injury. Paraplegia 26:83–86 15. Gerridzen RG, Thijssen AM, Dehoux E (1992) Risk factors for upper tract deterioration in chronic spinal cord injury patients. J Urol 147:416–418 16. Nosseir M, Hinkel A, Pannek J (2007) Clinical usefulness of urodynamic assessment for maintenance of bladder function in patients with spinal cord injury. Neurourol Urodyn 26:228–233
ORIGINAL ARTICLE
Protective effect of preserved bladder-filling sensation on upper urinary tract in patients with spinal cord injury Murat Erso¨z • Selc¸uk Sayılır
Received: 19 February 2014 / Accepted: 3 April 2014 Ó Springer-Verlag Italia 2014
Abstract In this study the possible preventive effect of bladder-filling sensation (BFS) on upper urinary tract deterioration (UUTD) in spinal cord injury (SCI) patients was investigated. Eighty-four (60 males, 24 females) patients with SCI who underwent neurourological assessment and urodynamic examinations because of neurogenic lower urinary tract dysfunction and were prescribed appropriate bladder management and were under follow-up and whose disease duration was at least 3 years were included in the study. Bladder-filling sensation was categorised as ‘‘absent’’, ‘‘partially preserved’’ or ‘‘preserved’’, and as ‘‘normal’’ (preserved) and ‘‘abnormal’’ (partially preserved, absent). Presence of hydronephrosis, renal stones, and chronic pyelonephritis in any renal USG or IVP performed during the follow-up period were accepted as criteria of UUTD. The frequencies of UUTD for BFS subgroups were determined and compared. Mean age and mean disease duration were 38.4 ± 13.0 years and 72.2 ± 36.2 months. The frequency of UUTD was 31/84 (36.9 %) in the study population. The frequencies of UUTD were 0/8 (0 %), 22/53 (41.5 %) and 9/23 (39.1 %) for ‘‘preserved’’ ‘‘partially preserved’’ and ‘‘absent’’ BFS subgroups, respectively (p = 0.074). There was a statistically significant difference between normal BFS [0/8 (0 %)] and abnormal BFS [31/76 (40.8 %)] subgroups
M. Erso¨z Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Yıldırım Beyazıt University, Ankara, Turkey M. Erso¨z (&) S. Sayılır Ankara Physical Medicine and Rehabilitation Training and Research Hospital of Ministry of Health, Ankara, Turkey e-mail: [email protected]
(p = 0.024). According to the results of our study preserved (normal) bladder-filling sensation has protective effect on upper urinary tract in patients with SCI. Keywords Spinal cord injury Bladder-filling sensation Upper urinary tract deterioration
Introduction Neurogenic lower urinary tract dysfunction (NLUTD) is common in patients with spinal cord injury (SCI) and can cause significant morbidity and reduce quality of life [1]. Assessment and management of NLUTD are mandatory in patients with SCI for prevention of upper urinary tract deterioration (UUTD). Evaluation of bladder-filling sensation during urodynamic studies, which guides daily urinary behaviour is important. Preservation of bladder-filling sensation (BFS) in some of the patients with spinal cord injury has been reported previously [2–8]. Although awareness of the sensations from bladder theoretically may help prevention of urinary tract, there is no specific study focused on the possible protective function of BFS on urinary tract. The aim of this study was investigation of possible preventive effect of bladder-filling sensation on upper urinary tract damage in SCI patients.
Materials and methods Eighty-four (60 male, 24 female) adult patients with SCI who underwent neurourological assessment and urodynamic examinations because of neurogenic lower urinary tract dysfunction and were provided appropriate bladder management and were under follow-up and whose disease
123
Neurol Sci
duration was at least 3 years were included in the study. The patients with normal basic urinary system tests including renal USG and IVP were enrolled in the study. The urodynamic reports of the patients were analysed retrospectively using the urodynamics laboratory records between 2002 and 2013. The age, gender, etiologic factor, disease duration, SCI level and class according to American Spinal Injury Association (ASIA) Impairment Scale (AIS) classification of the patients were recorded. Presence of hydronephrosis, renal stones and chronic pyelonephritis in any renal USG or IVP performed during the follow-up period were accepted as criteria of UUTD in patients whose basic urinary system tests including renal USG and IVP were normal [9]. Urodynamic investigations were performed by the same investigator (first author) using a Libra ? (MMS, Enschede, The Netherlands) urodynamic measurement system. Each patient was positioned supine on a urological table. An 8 Fr 2-lumen catheter for patients were introduced transurethrally for bladder filling. The bladder was emptied. Continuous medium fill cystometry was performed at 50 ml/min with room temperature sterile saline. Blood pressure was monitored during the cystometric examinations, and signs or symptoms of autonomic dysreflexia (AD) were monitored. The patients were informed about the bladder-filling sensations (first sensation of bladder filling, first desire to void and strong desire to void) before the investigation and were asked to report all sensations related to bladder filling, but not to report anything if they do not feel anything [11, 12]. Filling was terminated when the patient had a strong desire to void, when intravesical pressure reached 40 cm H2O or when significant leakage or symptoms of AD and blood pressure changes (systolic blood pressure higher than 140 or 20–40 mmHg increase in the systolic blood pressure [12]) occured. The BFS was categorised as ‘‘absent’’, ‘‘partially preserved’’ (different in quality or magnitude) and ‘‘preserved’’ (same as it was before the trauma) [5]. Then the frequencies of patients in BFS subgroups and UUTD frequencies in each BFS subgroup were determined. Upper urinary tract deterioration frequencies in normal (preserved) and abnormal (partially preserved, absent) BFS subgroups and in complete (AIS A) and incomplete (AIS B–E) SCI subgroups were also determined. The SPSS software Version 15.0 was used for data analysis. The data were expressed as the mean and standard deviation, as median or as frequencies when appropriate. p \ 0.05 was considered as statistically significant. The frequencies of UUTD for BFS subgroups, normal and abnormal BFS subgroups and complete and incomplete SCI subgroups were determined and compared by Chi square test or Fischer’s exact test when appropriate.
123
Table 1 Demographic and clinical features of the patients (n = 84) Mean age (years)
38.4 ± 13.0 (median = 36, range 18–71)
Disease duration (months)
72.2 ± 36.2 (median = 58, range 32–216)
Gender (female/male)
24 (28.6 %)/60 (71.4 %)
Level of lesion (cervical/thoracic/ lumbosacral)
16 (19.0 %)/51 (60.7 %)/17 (20.2 %)
AIS class (A/B/C/D/E)
53 (63.1 %)/14 (16.7 %)/10 (11.9 %)/7 (8.3 %)/0
Etiologic factors (vehicle accident/ fall/gun shot/diving/crushed)
31 (38.8 %)/34 (42.5 %)/4 (5.0 %)/3 (3.8 %)/8 (10.0 %)
Table 2 Bladder-filling sensation category frequencies in the study population and in incomplete and complete spinal cord injury subgroups Bladder-filling sensation frequency Preserved (%)
Partially preserved (%)
Absent (%)
All patients (n = 84)
8 (9.5)
53 (63.1)
23 (27.4)
Incomplete spinal cord injury (n = 31)
8 (25.8)
22 (71.0)
1 (3.2)
Complete spinal cord injury (n = 53)
0 (0)
31 (58.5)
22 (41.5)
Results Mean age and mean disease duration were 38.4 ± 13.0 (median = 36, range 18–71) years and 72.2 ± 36.2 (median = 58, range 32–216) months. Sixteen patients had cervical, 51 had thoracic and 17 had lumbosacral lesions. AIS classes were A in 53, B in 14, C in 10 and D in 7 patients. Demographic and clinical data of the patients are presented in Table 1. Bladder-filling sensation category frequencies in the study population and in incomplete and complete SCI subgroups are shown in Table 2. All the patients with preserved BFS were in the incomplete SCI group (3 AIS B, 3 AIS C, 2 AIS D). The frequency of UUTD was 31/84 (36.9 %) in the study population. The frequencies of UUTD for BFS subgroups are given in Table 3. The frequencies of UUTD were 0/8 (0 %), 22/53 (41.5 %) and 9/23 (39.1 %) for ‘‘preserved’’ ‘‘partially preserved’’ and ‘‘absent’’ BFS subgroups, respectively. There was no statistically significant difference between subgroups in Chi square test (p = 0.074). There was a statistically significant difference between normal BFS [0/8 (0 %)] and abnormal BFS [31/76 (40.8 %)] subgroups (p = 0.024). No statistically significant difference was observed between complete (AIS A)
Neurol Sci Table 3 Frequencies of upper urinary tract damage in bladder-filling sensation subgroups Bladder-filling sensation category Preserved
Upper urinary tract damage frequency (%) 0/8 (0)
Partially preserved
22/53 (41.5)
Absent Normal (preserved)
9/23 (39.1) 0/8 (0)
Abnormal (partially preserved, absent)
31/76 (40.8)
p
0.074
0.024
[23/53, (43.4 %)] and incomplete (AIS B–E) [8/31 (25.8 %)] SCI subgroups with respect to UUTD frequency (p [ 0.05).
Discussion Bladder-filling sensation which guides daily urinary behaviour in healthy subjects is a very important component of urinary function. An individual with normal BFS by the continuous sensorial inputs from the lower urinary tract can determine when to empty his or her bladder and can prevent his or her urinary tract from the destructive effects of overdistention. Furthermore, he or she can look for appropriate treatment in pathological conditions of the urinary tract like any obstruction in urinary tract, urinary tract infections, etc. by the help of the unpleasent sensations originated from these pathological conditions. In all these situations BFS theoretically appears as a protective function on urinary tract. Observation of high rates of upper urinary tract damage reaching 43 % in early SCI series is in accordance with this forementioned assumption as absence or severe deficits of BFS are frequent in this patient group [13–16]. However, no study has investigated the possible protective function of BFS on urinary tract in patients with SCI. We think that the statistically significant lower rate of UUTD in SCI patients with normal (preserved) BFS in comparison with abnormal BFS subgroups we observed in our study supports this assumption. Similar UUTD frequencies observed in partially preserved and absent BFS subgroups revealed that partially preserved BFS is not protective for UUTD. An important point to mention here is the distribution of the patients with preserved BFS in SCI lesion groups. All the patients with preserved BFS were in the incomplete SCI group (3 AIS B, 3 AIS C, 2 AIS D). Similar findings have been reported previously [5]. Although preserved BFS patients appeared as a subgroup of incomplete SCI group incompleteness of the SCI did not appear as a protective feature on urinary tract in our study. In a recent
study no statistically significant difference between complete and incomplete SCI patients in terms of upper urinary tract USG findings has been reported which was in accordance with our study results [9]. We feel that our study results further emphasized the importance of bladder-filling sensation investigations during urodynamic studies in SCI patients. Knowing the protective effect of preserved (normal) BFS on urinary tract in SCI patients and knowing the absence of this protective effect in partially preserved and absent BFS subgroups will help the physician during making more accurate therapuetic decisions in daily practice. However, all the patients with SCI including the ones with preserved BFS should be followed up strictly for prevention of any undesirable manifestations of the NLUTD. New prospective studies with larger sample sizes may help increasing our knowledge about the protective effect of BFS. In conclusion, we can say that preserved bladder-filling sensation has protective effect on upper urinary tract in patients with SCI. Bladder-filling sensation investigations should be carried out in SCI patients during urodynamic studies. Although preserved BFS appeared as a protective feature in SCI patients, the possibility of occurrence of UUTD should be kept in mind and appropriate and continuous management of the NLUTD should be carried out even in those patients with preserved BFS.
References 1. Whiteneck GG, Charlifue SW, Frankel HL, Fraser MH, Gardner BP, Gerhart KA et al (1992) Mortality, morbidity, and psychosocial outcomes of persons spinal cord injured more than 20 years ago. Paraplegia 30:617–630 2. Pavlakis AJ, Siroky MB, Goldstein I, Krane RJ (1983) Neurourologic findings in conus medullaris and cauda equina injury. Arch Neurol 40:570–573 3. Wyndaele JJ (1991) Investigation of the afferent nerves of the lower urinary tract in patients with ‘complete’ and ‘incomplete’ spinal cord injury. Paraplegia 29:490–494 4. Wyndaele JJ (1997) Correlation between clinical neurological data and urodynamic function in spinal cord injured patients. Spinal Cord 35:213–216 5. Ersoz M, Akyuz M (2004) Bladder-filling sensation in patients with spinal cord injury and the potential for sensation-dependent bladder emptying. Spinal Cord 42:110–116 6. Reitz A (2012) Afferent pathways arising from the lower urinary tract after complete spinal cord injury or cauda equina lesion: clinical observations with neurophysiological implications. Urol Int 89:462–467 7. Shin JC, Chang WH, Jung TH, Yoo JH, Park SN (2008) The determination of sensation-dependent bladder emptying time in patients with complete spinal cord injury above T11. Spinal Cord 46:210–215 8. Sayılır S, Erso¨z M, Yalc¸ın S (2013) Comparison of urodynamic findings in patients with upper and lower cervical spinal cord injury. Spinal Cord 51:780–783
123
Neurol Sci 9. Akkoc Y, Cinar Y, Kismali E (2012) Should complete and incomplete spinal cord injury patients receive the same attention in urodynamic evaluations and ultrasonography examinations of the upper urinary tract? Int J Rehabil Res 35:178–180 10. Wyndaele JJ (1998) The normal pattern of perception of bladder filling during cystometry studied in 38 young healthy volunteers. J Urol 160:479–481 11. Wyndaele JJ, Wachter SD (2002) Cystometrical sensory data from a normal population: comparison of two groups of young healthy volunteers examined with 5 years interval. Eur Urol 42:34–38 12. Consortium for spinal cord medicine (2006) Bladder management for adults with spinal cord injury: a clinical practice guideline for health-care providers. ISBN: 0-929819-19-5
123
13. Burke DC (1974) Traumatic spinal paralysis in children. Paraplegia 11:268–276 14. Fanciullacci F, Zanollo A, Sandri S, Catanzaro F (1988) The neuropathic bladder in children with spinal cord injury. Paraplegia 26:83–86 15. Gerridzen RG, Thijssen AM, Dehoux E (1992) Risk factors for upper tract deterioration in chronic spinal cord injury patients. J Urol 147:416–418 16. Nosseir M, Hinkel A, Pannek J (2007) Clinical usefulness of urodynamic assessment for maintenance of bladder function in patients with spinal cord injury. Neurourol Urodyn 26:228–233
