Study On The Bladder Function And Its Related Factors In Patients With Spinal Cord Injury

Objectives:To explore the bladder function in patients with spinal cord injury, figure out the effects of different injury site, injury level, injury course on bladder-emptying methods, analysis neurogenic bladder symptoms score and its related factors. In order to provide reasonable advice to improve the bladder management, so as to protect the patient's bladder function,reduce complications and improve the quality of life.Methods:1. Examed the urodynamic in 49 patients with spinal cord injury in our hospital. A nonparametric rank sum test was performed to analyze the related factors of bladder function among different injury sites, injury levels, injury course, bladder-emptying methods.2. 151 patients with spinal cord injury were involved in investigation of the bladder-emptying methods at different injury course, using descriptive statistical methods to analyze its changes with the extension of injury course. Using the non-parametric rank sum test to analyze the difference of the bladder-emptying method among different injury site and level.3. Translated and debugged the neurological bladder symptom score (NBSS) to form Chinese NBSS according to the Brislin translation model. The reliability of Chinese NBSS was evaluated by Cronbach's a coefficient and retest reliability. The validity of Chinese NBSS was evaluated by exploratory factor analysis and expert content validity index. 148 patients with spinal cord injury were investigated by NBSS. By using the injury site, injury level, injury course, bladder-emptying ways as the group variable and NBSS score, dimension score as the test variables, a single factor analysis of variance(ANOVA) was performed. Using injury site, injury site, injury level, injury course as independent variables and NBSS score as dependent variables, a stepwise linear regression was performed to analysis the related factors of the NBSS scores.Results:1. The results of bladder function in 49 patients with spinal cord injury revealed that 26 patients (53.1%) had low compliance; the patients with bladder sensory of normal.sensitive, decreased, missing accounted for 30.6%, 4.1%, 30.6%. 34.7% respectively;the patients with detrusor normal, detrusor over-active in the urine storage period accounted for 61.2%, 38.8% respectively; the patients with detrusor normal, detrusor muscle contractility low, detrusor without contraction in the urination period accounted for 4.1%, 42.9%, 53.1% respectively. Among the different injury sites, there was no statistically significant difference in bladder compliance and urinary detrusor function(P> 0.05), however, there was significant difference in bladder sensation , urine retention period of detrusor function and bladder capacity (P <0.05). Among the different injury levels, there was no statistically significant difference in bladder compliance , detrusor function and bladder capacity (P> 0.05), while significant difference in bladder sensation was detected (P <0.05). Among the different injury course, there was no statistically significant difference in bladder sensation and urinary detrusor function (P>0.05), however, there was significant difference in bladder compliance, urine retention period of detrusor function and bladder capacity (P <0.05). Among the different bladder-emptying methods, there was no statistically significant difference in bladder compliance, bladder sensation detrusor function and bladder capacity(P> 0.05).2. The urinary follow-up survey of 151 patients with spinal cord injury revealed that, the proportion of indwelling catheter, intermittent catheterization decreased, the proportion of incontinence, percussion / squeezing / abdominal pressure urination and self-urination increased with the extension of injury course. Follow the observation to more than 13 months, the highest proportion is indwelling catheter in the 90 patients of early indwelling catheter, accounting for 25.9%,43.3% among patients can urinate themselves in the 40 patients with early intermittent catheterization, but 16.7% among whom with incontinence. Bladder-emptying methods have a certain relationship among different injury sites, the main bladder-emptying method is self-urination in cervical,lumbar, sacral spinal cord injury and percussion / abdominal pressure / squeeze urination in thoracic spinal cord injury; and there also a certain relationship among different injury levels, self-urination is the main bladder-emptying method of complete injury and incomplete injury, but its proportion in complete injury is low, indwelling catheter accounting for 17.8%, the proportion of self-urination in incomplete injury patients is higher, but there are still 15.5% patients have indwelling catheter.3. The NBSS survey of 148 patients with SCI revealed that, among the injury sites, there was significant difference in incontinence dimension, storage and emptying dimension and total score (P <0.05), there was no significant difference in consequences dimension(P> 0.05). Among the injury levels, there was significant difference in incontinence dimension and total score (P <0.05), there was no significant difference in storage and emptying dimension and consequences dimension(P> 0.05). Among the different injury course, there was significant difference in incontinence dimension, storage and emptying dimension and total score (P <0.05), there was no significant difference in consequences dimension (P <0.05); there was significant difference in three dimensions and total score among the bladder-emptying methods (P <0.05). The stepwise multiple linear regression analysis revealed that, the risk of neurological bladder scores (injury sites, injury sites, injury course and bladder-emptying methods) was statistically significant among the total score of neurogenic bladder symptoms (F = 8.656, P = 0.000),can explain 69.6% of the variance.Conclusion:1. The bladder function is different from injury sites, injury levels and injury course in patients with spinal cord injury.2. The injury sites, injury sites, injury course affects bladder-emptying methods in patients with spinal cord injury.3. The injury sites, injury sites, injury course and bladder-emptying methods affect the neurogenic bladder symptoms score.