錄影尿動力學檢查在不同部位脊髓損傷患者之特徵

張天霖、郭漢崇

佛教慈濟醫療財團法人花蓮慈濟醫院 泌尿部

The video urodynamic characteristics in SCI patients with different injury level and bladder condition

Tien-Lin Chang, Hann-Chorng Kuo

Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan

Purpose:

The worldwide incidence of SCI reported in the literature ranges from 12.1 to 57.8 per million. Neurogenic voiding dysfunction is common in those patients with SCI, which causes failure to store due to detrusor overactivity or urethral incompetence and failure to emptying due to detrusor areflexia, bladder neck dysfunction or detrusor sphincter dyssynergia. These effects have great impact on quality of life. This study aims to distinguish the characteristics of neurogenic voiding dysfunction in patient with SCI by VUDS parameters and differences among different injury levels and bladder condition.

Materials and Methods:

This study is a retrospective survey on 393 men and 127 women with spinal cord injury in different level and neurogenic voiding dysfunction who had received video urodynamic study from Sep. 1997 to Aug. 2020. Exclusion criteria including patient with intracranial lesion (eg. CVA, Parkinson’s disease, dementia), peripheral neuropathy or metabolic disease such as DM neuropathy). VUDS were conducted to analyze the bladder function (DO, DHIC, DU, BND and DSD) and parameters in different injury level.

Results:

The mean age was 44.2±15.7 years old and the time to first VUDS was 81.8±89.0 months. Detrusor overactivity is noted significantly more in patients with cervical SCI than in those with thoracic or lumbar SCI in male patients, where as significantly more patients with lumbar SCI had detrusor underactivity in both genders. In VUDS parameters, there is significantly lower first sensation of filling (FSF), full sensation (FS) and urge sensation (US) in male patients with cervical SCI. Furthermore, Pdet is noted significantly more in patients with cervical SCI and T1-T6 SCI in both genders. There is no significant difference in the post-void residual volume (PVR), maximum flow rate (Qmax), corrected maximum flow rate (cQmax), and voiding efficiency (VE) in different injury level.

Conclusions:

The real-world VUDS revealed that patients with high level SCI had a high prevalence of DO and following higher Pdet, where as significantly more patients with lumbar SCI had detrusor underactivity. The VUDS characteristics may influence the management of patient with SCI and voiding dysfunction in clinical practice. Hence a precise VUDS will be helpful in the assessment in these patients.