EARLY PREDICTORS OF BLADDER RECOVERY AND URODYNAMICS AFTER SPINAL-CORD INJURY

Our purpose was to determine if intact perianal (S4-5) pin sensation ( PPS) and bulbocavernosus (S2-4) reflex (BCR) shortly after spinal cord injury (SCT) are predictive of bladder function recovery. Twenty-eigh t SCI patients (aged 18-68 years, Frankel Classification A-D, spinal i njury level C4-T12), admitted within 72 hours of injury, underwent eva luation of initial PPS and BCR. The presence of intact PPS and BCR wer e correlated with the patient's voiding function and urodynamic evalua tion results 1 year postinjury. Of the 28 patients within 72 hours of SCI, PPS was intact in 17 (60%) and absent in 11 (40%), while 15 patie nts (54%) demonstrated a positive BCR and 13 (46%) did not. One year a fter SCI, no patient with absent PPS voided unassisted, while of the 1 7 patients with preserved PPS, 11 (65%) were voiding spontaneously. Of these 11 patients, urodynamic evaluation revealed detrusor areflexia in 1 (9%), normal detrusor function in 2 (18%), and detrusor hyperrefl exia in 8 (73%), with 3 of these 8 patients (38%) also demonstrating d etrusor-sphincter dyssynergia. At 1 year postinjury, only 2 of 13 pati ents (15%) with an absent BCR voided spontaneously, while 9 of 15 pati ents (60%) with an intact BCR were able to void. Although PPS and BCR are moderately sensitive in predicting the return of spontaneous voidi ng, they cannot predict detrusor hyperreflexia and sphincter dyssynerg ia. Therefore, urodynamic study remains an essential component of init ial urologic evaluation after SCI. (C) 1998 Wiley-Liss, Inc.