LOWER URINARY CHANGES OVER TIME IN SUPRASACRAL SPINAL-CORD INJURY

This paper reviews 179 patients (23 females and 156 males) with supras acral spinal cord injury (SCI) who underwent videourodynamic evaluatio n to compare maximum detrusor pressure, compliance, and trabeculation with methods of bladder management, years postinjury, and age. The pat ients were divided into four groups based on mode of bladder managemen t: clean intermittent catheterization (CIC), indwelling catheter (IND) , external collector (EC), and voiding (V). Maximum pressure decreased significantly with increasing age for those using EC (P < 0.01) and C IC (P < 0.05). Maximum pressure also decreased significantly with year s post-injury for patients on EC (P < 0.01) and was highest the first decade after injury and progressively decreased through the fifth deca de. Post-hoc tests indicated more severe trabeculation in patients in the EC group than in either the CIC or IND groups. Age and trabeculati on did not correlate in those on EC. We conclude that patients with lo ng-standing suprasacral SCI using EC are more likely to have lower det rusor pressures than are those with less chronic SCI. This finding may reflect the effects of age as well as reduced survival in those using EC with chronically elevated detrusor pressure.