Association of level of injury and bladder behavior in patients with post-traumatic spinal cord injury

Objectives. The expected urodynamic findings of patients with suprasacral a nd sacral spinal cord injury have previously been reported. However, the as sociations between the radiographically determined level or levels of injur y and urodynamic findings are ill defined. This study investigated these re lationships, specifically the bladder behavior of patients with post-trauma tic spinal cord injury with combined suprasacral and sacral injuries. Methods. A retrospective review of the patient records, spinal imaging stud ies, and video-urodynamic studies of 316 patients with post-traumatic spina l cord injury was performed. Of these patients, 243 had complete spinal com puted tomography or magnetic resonance imaging studies and constitute the s tudy population. Patients were categorized by the radiographically determin ed level or levels of injury, clinical neurologic level and completeness of injury, and urodynamic findings. Results. Of the 196 patients with suprasacral injuries, 186 (94.9%) demonst rated hyperreflexia and/or detrusor sphincter dyssynergia, 82 (41.8%) had l ow bladder compliance (less than 12.5 mL/cm H2O), and 79 (40.3%) had high d etrusor leak point pressures (greater than 40 cm H2O). Of the 14 patients w ith sacral injuries, 12 (85.7%) manifested areflexia, 11 (78.6%) had low co mpliance, and 12 (85.7%) had high leak point pressures. Of the 33 patients with combined suprasacral and sacral injuries, urodynamic studies showed 23 with hyperreflexia and/or detrusor sphincter dyssynergia (67.7%), 9 with a reflexia (27.3%), 19 (57.6%) with low compliance, and 20 (60.6%) with high leak point pressures. Conclusions. In patients with a single level of spinal cord injury, this st udy revealed a significant association between the level of injury and the type of voiding dysfunction. Patients with combined suprasacral and sacral injuries, as identified with precise spinal imaging techniques, had relativ ely unpredictable urodynamic findings. Management of the urinary tract in p atients with spinal cord injury must be based on urodynamic findings rather than inferences from the neurologic evaluation. UROLOGY 55: 490-494, 2000. (C) 2000, Elsevier Science Inc.