The significance of urodynamic analysis in evaluating neurogenic vesicoureteral reflux in patients with thoracolumbar spinal cord injury

Abstract

Objective To investigate the utility of urodynamic testing in the evaluation of neurogenic vesicoureteral reflux in patients with thoracolumbar spinal cord injury at the T10 to L2 level. Methods Twenty-six patients with thoracolumbar spinal cord injury at the T10 to L2 level and who displayed vesicoureteral reflux were enrolled and divided into a detrusor hyper-reflexia group (n=21) and a detrusor a-reflexia group (n=5) according to their cystourethrograms and urodynamic test results. Their bladder volume, detrusor pressure (Pdet) and compliance were observed and analyzed at the vesicoureteral reflux point and the leak point. Results The bladder volume and compliance of the detrusor hyper-reflexia group at the vesicoureteral reflux point were (122.46±87.89) ml and (5.94±4.96) ml/H2O respectively, significantly different from the detrusor a-reflexia group (P<0.01). At the leak point, the average bladder volume of the detrusor hyper-reflexia group was (210.81±69.72)ml, while the average bladder compliance was (9.53±5.43)ml/H2O and the average detrusor pressure was (42.29±9.57)cm H2O. All were significantly different from the detrusor a-reflexia group's averages. Moreover, there was a significant difference in the Pdet between the leak point and the vesicoureteral reflux points in the detrusor hyper-reflexia group. Conclusions Patients with thoracolumbar spinal cord injuries at the T10 to L2 level with neurogenic bladder and detrusor hyper-reflexia have low bladder volumes and compliance, and vesicoureteral reflux tends to occur at an early stage after injury with a destrusor pressure lower than 40 cm H2O. For patients with detrusor a-reflexia, vesicoureteral reflux and bladder leakage may occur when detrusor pressure is low. Key words: Spinal cord injury; Neurogenic bladder dysfunction; Vesicoureteral reflux; Urodynamics