A Study On The Bladder Dysfunction After Lumbosacral Spinal Cord Injury And The Discussions Of Related Urinary Control Mechanism

Central nervous system damage is one of the important causes leading to the urine storage and voiding dysfunction, and its incidence rate with the increasing of the aging of our population and the traffic accident and the brain, spinal cord operation and gradually rise, serious influence patient’s quality of life, increased social economic burden. A serious complication is the dysfunction of urinary system after spinal cord injury, can cause severe urinary retention and urinary tract infection, is one of the leading causes of death in patients with spinal cord injury. Cerebrovascular disease is a common disease in elderly men, in the acute phase often appear abnormal urination urine storage and, in some cases even in the recovery period will not improve voiding symptoms. The purpose of this study was to investigate the lumbosacral spinal cord injury and pons above central injury of bladder dysfunction and urodynamic characteristics. And thoracolumbar may exist continence mechanism analysis and exploration.Objective: To compare the differences of bladder dysfunction and urodynamic characteristics between suprapontine neuropathy and lumbosacral spinal cord injury and the possible mechanism of urinary control analysisMethods: The clinical data of 91 cases of patients with central nervous system damageadmitted in our hospital from March 2008 to May 2014 were retrospective studied, including the clinical manifestations, diagnosis, urination way, residual urine, urodynamics. There were 49 cases of suprapontine neuropathy and 42 cases of lumbosacral spinal cord injury. The free flow rate parameters and cystometric parameters of two groups were compared.Results: There was no significant difference in the maximum free flow rate and urine output volume between two groups(P>0.05). The residual urine volume of suprapontine neuropathy group was lower than that of the lumbosacral spinal cord injury group(P<0.05). The bladder volume of suprapontine neuropathy was smaller than that of the lumbosacral spinal cord injury group(P<0.05). The maximum detrusor pressure, flow rate and detrusor pressure and the average pressure of voiding period of suprapontine neuropathy group were all higher than those of the lumbosacral spinal cord injury group(P<0.05). Significant differences were found in the bladder compliance bladder sensation and detrusor stability between two groups(P<0.05).Most of the suprapontine neuropathy patients performanced bladder sensory sensitivity(29/49), while lumbosacral spinal cord injury group much more performanced reduced bladder sensation and absent bladder sensation(23/42).Low compliance bladder was mainly found in the suprapontine neuropathy patients(31/49), while high compliance bladder was mainly found in the lumbosacral spinal cord injury group(24/42). The suprapontine neuropathy group mostly showed detrusor overactivity(38/49), lumbosacral detrusor much performance had no reflection or weak reflection(25/42)Conclusions: The patients with suprapontine neuropathy mainly showed detrusor hyperreflexia, small capacity bladder and low compliance bladder, while most patients with lumbosacral spinal cord injury showed decreased detrusor contractility and high compliance badder. lumbosacral spinal cord(L2~S1)and The cerebral cortex may exist conduction accessory pathway.