Bladder Recovery Research Articles

腰椎疾患におけるぼうこう機能の術前後の比較検討

We carried out a urodynamic study pre and post-operatively in nine patients who had neurogenic bladder caused by lumbar spinal disease and investigated their transition and prognosis.The study involved five male and four female patients ranging in age from 37 to 72 years, average age 63 years. They consisted of six lumbar spinal canal stenosis, and one case each of lumbar disc herniation, epidural abscess and epidural tumor.Six patients recovered but three did not. Three patients in the recovered group had no urinary symptoms and the other three had only mild symptoms such as difficulty of urination or a sense oresidual urine. On the other hand, the patients in the non-recovery group suffered from severe symptoms, such as anuresis.However the duration of urinary symptoms in the recovered group was longer than in the non-recovery group.From this study, we concluded that conditions for recovery of the neurogenic bladder include both the possibility of urination even if compensated by abdominal presssure and for the patient to have a moderate remaining sense of the urinary bladder.

Urodynamic findings with disc protrusion

The medical literature on functional bladder problems with disc protrusion is reviewed. The majority of reports concern central lumbar disc protrusion, the main effect of which is bladder hypofunction, with variable degrees of urinary retention. The lack of bladder training in the pre-intermittent catheterization era probably explains the unfavorable bladder recovery reported by past authors. According to the author's experience, intermittent self-catheterization permits the patient to obtain a balanced bladder condition in most cases. Also, upper urinary tract conditions remain good, and close follow-up is mandatory.

Chronic Urinary Retention Postpartum

Three cases of chronic urinary retention postpartum are reported. All patients were primigravidas. Unrecognized urinary retention following epidural anaesthesia in labour was the likely cause. Abdominal ultrasound may have a place in early recognition of this complication. The early use of a suprapubic catheter hastens bladder recovery.

Long-term recovery and reirradiation tolerance of mouse bladder

The aim of this study was to investigate the influence of overall treatment time on the development and repair of radiation injury in the bladder. The bladders of mice were irradiated with 2 equal doses of X rays separated by 1 day, 3 months or 9 months. Additional groups of mice were given 8 or 16 Gy (approximately 20% and 60%, respectively, of a full tolerance dose) and subsequently reirradiated with a range of test doses after 3 or 9 months. Functional bladder damage was assessed from measurements of urination frequency and bladder compliance (measured cystometrically). There was a very early onset of functional damage (within 2 weeks) when mice were reirradiated 9 months after a dose of 16 Gy. Lower initial doses of 8 Gy did not alter the time of expression of damage after reirradiation. The early damage was probably due to stimulated cellular proliferation, which occurred after 16 Gy but not after 8 Gy, causing rapid expression of retreatment injury. Reirradiation tolerance for late bladder damage was inversely related to the dose given in the first treatment but was independent of the interval between treatments. There was no evidence for increased tolerance as the interval between treatments increased from 1 day to 9 months, which suggests that protracting the overall treatment time will not lead to sparing of late radiation damage in the bladder.

Cauda Eqiuina Syndrome

Six cases of acute postdiscectomy cauda equina syndrome (C.E.S.) following lumbar discectomy were reviewed retrospectively in a series of 2842 lumbar discectomies over a ten-year period. Five cases had coexisting bony spinal stenosis at the level of the disc protrusion. The bony spinal stenosis was not decompressed at the time of discectomy. Inadequate decompression played a role in the neurologic deterioration postoperation. The cause of the sixth case is unknown. Bowel and bladder recovery was good when the cauda equina decompressed early; sensory recovery was universally good, and motor recovery was poor if a severe deficit had developed before decompression. Careful review of the preoperative myelogram to rule out spinal stenosis and decompression of bony stenosis at discectomy are recommended for prevention of postoperative C.E.S. Urgent decompression of postoperative C.E.S. is advisable if compression of the cauda equina is confirmed radiographically.

New trends in urologic management of spinal cord injured patients.

We have attempted to address some of the current issues and new trends in the urologic management of SCI patients. Although tremendous progress has been made with these patients, resulting in a significant lowering of renal morbidity and mortality, there is still room for improvement. Newer methods of bladder management and refinements of older techniques are being sought. Progress in treating urinary infections should occur through development of new antibacterials and through improved understanding of host-bacterial interactions. Research into these problems and the general management of the neurologic dysfunction in SCI offers the hope of an even brighter future for these severely disabled patients.

Anterior decompression of traumatic thoracolumbar fractures with incomplete neurological deficit using a retroperitoneal approach.

Between 1973 and 1981, seventy patients with a spinal cord injury secondary to a thoracolumbar fracture were treated by anterior spinal-canal decompression through a retroperitoneal approach. All of these patients had an incomplete neurological deficit caused by retropulsed vertebral-body fragments and intervertebral disc material in the spinal canal. Forty-eight patients have been followed for an average of 3.4 years (range, two to 8.6 years). Either computed tomography or lateral tomography, or both, was performed after surgery on these forty-eight patients, and confirmed the successful removal of the cause of compression in all of them. No patient lost further cord or cauda equina function after the anterior decompression. Thirty-seven of the forty-two patients who had a motor deficit improved by at least one class in motor strength. Fourteen of the thirty patients whose quadriceps and hamstrings were too weak to permit walking regained full independent walking ability. Twelve of the thirty-two patients who had a conus medullaris injury demonstrated neurogenic bowel and bladder recovery. The degree of neurological recovery of spinal cord injury after anterior spinal decompression of thoracolumbar fractures appears more favorable than after other, previously reported techniques that do not decompress the spinal canal.

Bladder Recovery in Patients With Traumatic Cervical Cord Injury Evaluated by Voiding Synchronous Cystosphincterometry With Uroflowmetry

Voiding synchronous cystosphincterometry with uroflowmetry was used in 16 patients with traumatic cervical cord injury to evaluate bladder recovery. This method was shown to be reliable since the statistical analysis of the voiding responses showed the same values with repeated tests. A total of 14 patients with such injuries recovered from shock in 6 weeks and 10 acquired mature bladder contraction with a synergic external sphincteric urethra approximately 13 weeks after spinal cord injury. Bladders in patients with cervical cord injury usually recover from a state of inactive detrusor to that of a mature contraction by way of immature small and/or sustained contractions. Pressure measurements revealed 7.1 plus or minus 3.7cm. water in the empty bladder and 74 plus or minus 20.5cm. water (43 plus or minus 13.3 seconds in duration) in the recovered bladder contraction. Resting pressure in the external sphincteric urethra was 70 plus or minus 25.3cm. water. The dyssynergic sphincter coexists with immature sustained bladder contraction and it usually improves to the synergic state, according to the degree of maturity of bladder contraction. The bladder and external urethral sphincter recover independently and a synergic response develops even in cases of complete lesions. Thus, synergy can be accomplished by regulatory mechanisms at the sacral cord level. Surgical intervention should be postponed if the maturity of bladder contraction is not yet established. More precise objective information on the dyssynergic bladder caused by cervical cord injury can be obtained when voiding synchronous cystosphincterometry with uroflowmetry is used.

Midline prolapse of a lumbar intervertebral disc with compression of the cauda equina

Midline prolapse of a disc causing compression of the cauda equina is rare but needs urgent diagnosis and surgical treatment. The onset of bladder and rectal paralysis with saddle anaesthesia should be viewed with a high index of suspicion in a patient with backache and sciatica. Eight cases were seen over a period of five years, and they fell into three clinical groups. Group I patients presented with a sudden onset without any previous symptoms related to the back. Group II patients had a history of recurrent episodes of backache and sciatica, the latest episode resulting in involvement of the cauda equina. The group III patient was indistinguishable from one with a tumour as he presented with backache and sciatica slowly progressing to paralysis of the cauda equina. The prolapse was at the disc between L5 and S1 vertebrae in 50 per cent of the patients, most of whom did not have any limitation of straight leg raising. Urgent myelography and equally urgent removal of the disc within two weeks of the onset of the symptoms resulted in almost complete motor and bladder recovery within five months after the operation in most cases. However, recovery of sensation and sexual function was incomplete even four years after the operation.

Patterns of bladder recovery in spinal injury evaluated by serial urodynamic observations

The results of serial urodynamic studies in spinal cord injury are presented. A number of signs which may be useful in the prediction of patients who will eventually establish spontaneous and satisfactory voiding are described. (1) Some patients with cervical high/thoracic lesions show evidence of synchrony between the external sphincter and the detrusor muscle in the phase of spinal shock. Spontaneous and efficient voiding usually occurs in this group. (2) Some patients, especially those with mid-thoracic lesions show marked dyschrony between the external sphincter/detrusor muscle in the phase of spinal shock. Early outlet surgery is indicated in this group since spontaneous and efficient voiding rarely occurs. (3) A zone of high pressure can be detected in the posterior urethra in the phase of spinal shock often within the first week after injury.

Herpes Zoster With Neurogenic Bladder Dysfunction

Eight patients who had herpes zoster associated with neurogenic bladder dysfunction were studied. The herpes zoster eruption appeared in the sacral dermatomes (S2-S4) in five patients, in the ilioinguinal dermatomes (L1-L2) in two patients and in the thoracic dermatome (T12) in one patient. Acute urinary retention and polyuria were present in six patients. Other visceral symptoms included dysuria, hematuria, constipation, and impotence. Laboratory results were less discriminating, although three patients had combinations of hematuria, pyuria, and bacillurla, and two of the four patients studied had flaccid neurogenic bladders, as determined by cystometrograms and residual urine measurements. There was complete recovery of bladder and bowel function within two to four weeks. This recovery paralleled the resolution of the zoster eruption.

Herpes zoster with neurogenic bladder dysfunction

Eight patients who had herpes zoster associated with neurogenic bladder dysfunction were studied. The herpes zoster eruption appeared in the sacral dermatomes (S2-S4) in five patients, in the ilioinguinal dermatomes (L1-L2) in two patients and in the thoracic dermatome (T12) in one patient. Acute urinary retention and polyuria were present in six patients. Other visceral symptoms included dysuria, hematuria, constipation, and impotence. Laboratory results were less discriminating, although three patients had combinations of hematuria, pyuria, and bacillurla, and two of the four patients studied had flaccid neurogenic bladders, as determined by cystometrograms and residual urine measurements. There was complete recovery of bladder and bowel function within two to four weeks. This recovery paralleled the resolution of the zoster eruption.

Suprapubic trocar cystostomy

Suprapubic trocar cystostomy was used to provide bladder drainage in 80 patients operated upon for symptomatic uterovaginal relaxation and stress incontinence. The group is compared to 100 patients managed by a transurethral catheter routine. Time of initial voiding, bladder recovery time, morbidity, and costs between the two groups are compared. The advantages of cystostomy are increased patient comfort, better utilization of hospital personnel, and decreased cost.