THE LOCATION OF THE PATHS SUBSERVING MICTURITION - STUDIES IN PATIENTS WITH CERVICAL MYELOPATHY

Urodynamic studies and neurological examinations were performed on 128 patients with cervical myelopathies including 82 with spondylitic mye lopathy and 46 with ossification of the posterior longitudinal ligamen t (OPLL), investigating the location of the paths subserving micturiti on in the spinal cord, Accurate history taking revealed micturitional symptoms in 95 patients, including irritative symptoms in 61 and obstr uctive symptoms in 71. Urinary incontinence was noted in 25 and residu al urine of over 100 mi or retention was found in 22. Neurological exa mination revealed disturbed deep sensation in 55, disturbed superficia l sensation in 63 and pyramidal signs (weakness, hyperreflexia of legs and Babinski sign) in 96 patients. Urodynamic studies revealed uninhi bited contraction in 61 and detrusor-sphincter dyssynergia in 22 patie nts. Bladder capacity was smaller in patients with Babinski sign (P < 0.05) and in patients with uninhibited contraction (P < 0.001), Uninhi bited contraction was more frequent in patients with all three of the above-mentioned pyramidal signs (P < 0.05). Detrusor-sphincter dyssyne rgia was more frequent in patients with disturbed deep sensation(P < 0 .05) and pyramidal signs (P < 0.05, P < 0.0005). From above results an d our previous findings in patients with anterior spinal artery syndro me and with tabes dorsalis, it is concluded that the pathway subservin g detrusor function seems to be located mainly in the lateral column o f the spinal cord. The descending pathway subserving coordination of b ladder and urethral sphincter seems to be located mainly in the latera l column, and its ascending pathway seems to be located in the dorsal column. The path subserving urinary sensation seems to be located main ly in the dorsal column of the spinal cord.