Clinical Research Of The Influence Of Body Positioning To Urinate Generation In Patients With Neurogenic Bladder From Spinal Cord Injury And Bladder Capacity Measure

Objective:1. To explore the influence of body positioning to the urine generation in patient with Neurogenic Bladder (NB) from spinal cord injury (SCI) and to define the time point of the clean intermittent catheterization for these patients. 2. To explore the difference between self-generation urine and common method measure the bladder volumetric in patient with NB from SCI.Method: 1. Thirty six SCI patients with NB were included. Supine lying, long leg sitting and short leg sitting were performed in all patients separately in consecutive 3 days. All subjects were fasted in the morning. Indwelling catheterization was performed for empting bladder. All patients required to drink 500ml water within 10min. Urine volume record was then taken every 30 min until reached 500 ml. 2. Fifteen SCI patients with NB were included. Self-generation urine and common method measured their bladder volumetric in all patients separately in consecutive 2 days. Bladder volumetric determination by self-generation urine: All subjects were fasted in the morning. Indwelling catheterization was performed for empting bladder after voluntary micturition. Residual urine volume record was taken. All patients required to drink 500ml water within 10min. Install bladder volumetric-pressure metering equipment, observing the pressure of piezometer. Stop the operation when the pressure≥40cmH2O persistent or urine overflowing from urethral orifice. Record the urine volume, this is bladder security capacity. Conventional method: conditions with the former. Pour normal saline of 37℃continued to the bladder, observation and operation standards to stop with the former, measure and record the security capacity of the bladder.Result: 1. In supine, urine generation post 500ml water intake reached peak at 1.5 hrs (116.0±5.6 ml), remained plateau at 2.0 and 2.5 hrs (102.1±5.7 ml, 112.5±5.3 ml) and then declined gradually. Long leg sitting and short leg sitting had 0.5 hr and 1.0 hrs delay time to the peak of urine generation. The time to generate 400ml urine was 3.0, 4.0 and 5.0 hrs in the positions of supine, long leg sitting and short leg sitting, respectively. Linear regression for urine generation and duration at supine, long leg sitting and short leg sitting were y=344.18Ln(x)-2.9499, R~2=0.9638 ; y=65.458x+31.203, R~2=0.9656and y=138.28x-193.88, R~2=0.9961, respectively. 2. The results of volumetric determination were: self-generation urine, 263.0±82.5ml; conventional method, 86.7±57.6ml, respectively. Security of bladder capacity by self- generation urine determination is bigger than that by conventional method, there was statistical differences between the two methods (P <0.05).Conclusion: 1. Body positioning has significant influence on urine generation in SCI patients with NB. The positive linear regression between urine volume and time at 3 positions can be used as guideline for bladder training and clean intermittent catheterization. 2. The results of bladder volumetric determination by self-generation urine is more accurate than that by the common method. This way can be applied to the bladder capacity–pressure determination of the small-capacity bladder.