Neuropathic bladder dysfunction in patients with motor complete and sensory incomplete spinal cord lesion.

STUDY

DESIGN

A retrospective study of patients with motor complete spinal cord lesion and somatosensory preservation (American Spinal Injury Association (ASIA) impairment scale B).

OBJECTIVE

To determine whether neuropathic bladder dysfunction is more or less severe with more or fewer complications in patients with somatosensory preservation.

SETTING

2nd Department of Physical and Rehabilitation Medicine, Neuropathic Bladder Unit, National Rehabilitation Center, EIAA, Athens, Greece.

METHODS

The classification of spinal cord injured patients was determined according to ASIA protocol. All patients underwent urodynamics and retrograde cystography, with a follow-up period of at least 18 months. The study sample consisted of 154 patients: 28 ASIA B patients compared with 126 ASIA A patients. We analyzed 140 traumatic and 14 nontraumatic lesions for (1) specific type of neuropathic bladder, (2) detrusor overactivity volume and pressure, (3) bladder compliance, (4) vesicoureteric reflux, (5) formation of bladder stones, (6) method of bladder emptying and (7) daily dose of anticholinergics needed to achieve safe bladder function. We also studied the presence of spasticity, autonomic dysreflexia and pain syndrome.

RESULTS

Statistically significant differences were found between ASIA A and B patients in daily dose of anticholinergics needed to achieve safe bladder function, in the incidence of incontinence episodes and in formation of bladder stones.

CONCLUSION

Patients with somatosensory incomplete lesion of spinal cord seem to have an advantage in the management of neuropathic bladder dysfunction (fewer anticholinergics needed, fewer incontinence episodes and fewer bladder stones).