Annals of Rehabilitation Medicine

Availability of a Newly Devised Ambulatory Urodynamic System in Spinal Cord Injury.: Son, Soo Yon , Seo, Jeong Hwan , Ko, Myoung Hwan , Park, Sung Hee , Song, Chul Gyu , Kim, Keo Sik; J Korean Acad Rehabil Med 2009;33(5):600-606.

Abstract
PDF

Objective
To introduce and evaluate the availability of a newly devised ambulatory urodynamic system using the abdominal EMG (electromyography) method instead of the rectal catheter in measuring the abdominal pressure, and to compare with conventional urodynamic system in patients with spinal cord injury. Method: We examined 15 hospitalized subjects with spinal cord injury. Patients were investigated by conventional urodynamics in an examination room, and followed by ambulatory urodynamics in a ward. We used the abdominal EMG and the rectal catheter for the abdominal pressure in the study. We measured urodynamic parameters : volumes of sensations in bladder filling, peak Pdet(detrusor pressure) during filling, maximal Pdet during voiding, bladder capacity, compliance and duration of filling. Results: There was no significant statistic difference in the parameters between the conventional and the ambulatory urodynamics. There were strong correlations between the parameters measured by the rectal catheter and the abdominal EMG in the ambulatory system and between the parameters in the conventional system and in the ambulatory system. Conclusion: There were strong correlation and no significant statistic differences in the parameters between the ambulatory system using abdominal EMG method and the conventional system. Therefore, we suggest that the newly devised ambulatory urodynamic system using abdominal EMG method can be used instead of the conventional non-ambulatory system and the conventional ambulatory system. (J Korean Acad Rehab Med 2009; 33: 600-606)

1,280 View
9 Download

Errors of Rectal Pressure Measurement in Urodynamic Study of Spinal Cord Injured Patients.: Seo, Jeong Hwan , Lee, Roo Ji , Park, Sung Hee , Jeong, Young Beom , Song, Chul Gyu; J Korean Acad Rehabil Med 2006;30(6):571-574.

Abstract
PDF

Objective
The intrarectal pressure can make error during urodynamic study and can decrease the accuracy of detrusor pressures. The purpose of this study was to investigate the incidence and cause of the error in measurement of recral pressure. Method: Forty-eight patients with spinal cord injury were enrolled. With the patients in the lithotomy position, catheter was placed into the bladder and the rectum, then urodynamic testing began by infusion of normal saline (20∼30^oC) via urethral catheter. The errors by measurement of rectal pressure during urodynamic study were recorded. According to the position of patients and spasticity of hipflexors, difference of rectal pressure was investigated. Results: The error rate of intrarectal pressure during urodynamic study was 41%. Intrarectal pressure was higher in lithotomy position than in lateral lying position. According to modified Ashworth scale of hip flexors, intrarectal pressure in grade 0 was significantly lower than grade 1, 1.5 and 2 (p＜0.05). Conclusion: There was significant errors in measuring of the intravesical pressure during urodynamic study. These factors might be posture, spasticity of hip flexors, and expelling of the catheter in urodynamic study. (J Korean Acad Rehab Med 2006; 30: 571-574)

1,390 View
6 Download

Evaluation of Neurogenic Bladder with Newly Developed Natural-fill Cystometric Device : Cases report.: Yoon, Seung Hyun , Lee, Il Yung , Kim, Seung Hwan , Lee, Young Seop , Rah, Ueon Woo , Yim, Shin Young; J Korean Acad Rehabil Med 2006;30(2):195-198.

Abstract
PDF

We developed a new, affordable, and easy-to-use natural-fill cystometric device to overcome the limitation of conventional cystometry, long been criticized for being unphysiological. The device was composed of one transurethral catheter, one rectal catheter, two digital manometers, and a portable computer. The transurethral and rectal catheters were connected to manometers, which were then connected to the computer. Three persons with neurogenic bladder were recruited for testing the device. To shorten the test duration, we gave patients 500 ml water before the test. As urine filled inside the bladder, the transurethral and rectal catheters transmitted respectively the intravesical and abdominal pressures to the digital manometers. The pressures were stored within the portable computer and turned into graphs indicating pressure changes. The natural-fill cystometry is thought to be a physiological test that is affordable and convenient because of its simple structure and small size. (J Korean Acad Rehab Med 2006; 30: 195-198)

1,417 View
13 Download

Motor Unit Action Potentials of the Rectus Abdominis Muscle according to Changes of Abdominal Pressure.: Seo, Jeong Hwan , Kim, Kwan Min , Ko, Myoung Hwan , Park, Sung Hee , Kim, Nam Gyun; J Korean Acad Rehabil Med 2005;29(5):457-461.

Abstract
PDF

Objective
In current urodynamic studies, rectal catheters can cause erroneous result affecting detrusor pressure, and the catheter itself is not comfortable to the patients. To reduce these problems we investigated the relationship between the motor unit action potentials (MUAP) of rectus abdominis muscle and the abdominal pressure measured by rectal catheter.Method: Healthy seven men and three women volunteers (mean age: 49 years) with no neurological abnormality were enrolled. Possible maximal abdominal pressure (Pmax) was attained by Valsalva maneuver for 5 seconds. The MUAPs of the rectus abdominis muscle were recorded with surface electrodes for analysis. These recordings were done on 100, 80, 60, 40, and 20% of Pmax. The parameters of MUAP such as mean frequency, median frequency, turns, mean amplitude, and RMS (root mean square) were measured. Results: Turns, mean amplitude, and RMS　were increased in a proportion to the increment of abdominal pressure in all subjects (R=0.840, 0.879, and 0.984, respectively). Conclusion: These findings suggested that the surface MUAP of rectus abdominis muscle might be used indirectly for more convenient measurement of the abdominal pressure. (J Korean Acad Rehab Med 2005; 29: 457-461)

1,302 View
3 Download

The Effects of Detrusor and Urethral Pressure on Semen Quality in Patients with Spinal Cord Injury.: Kim, Yong Wook , Shin, Ji Cheol , Park, Chang Il , Lee, Jin Woo; J Korean Acad Rehabil Med 2003;27(6):875-879.

Abstract
PDF

Objective: To evaluate the influences of detrusor and urethral pressure on the sperm quality in spinal cord injured male patients.

Method: 34 spinal cord injured male patients were participated in this study. We measured the maximal detrusor pressure, compliance of detrusor, involuntary detrusor reflex and urethral pressure by urodynamic study. And we induced ejaculatory stimulation by vibratory (Ferticare^Ⱂ) and electrical stimulation (Seager^Ⱂ) and analyzed the sperm volume, the concentration, the total sperm count, the motile sperm count and motility. Analysis of variance (ANOVA) and paired t-test were used to compare sperm quality among groups of urodynamic parameters.

Results: Semen quality such as sperm concentration, sperm volume, motile sperm count was significantly (p＜0.05) better in patients with low maximal detrusor pressure, high detrusor compliance, normtonic urethral pressure than with high maximal detrusor pressure, low detrusor compliance, hypertonic urethral pressure, regardless of involuntary detrusor reflex.

Conclusion: The proper management of neurogenic bladder for improving semen quality in spinal cord injured male patients may be needed for better pregnant outcomes. (J Korean Acad Rehab Med 2003; 27: 875-879)

1,792 View
7 Download

Assessment of Bladder Function in Adults with Cerebral Palsy; A Preliminary Study.: Park, Eun Sook , Park, Chang Il , Cho, Sung Rae , Shin, Ji Cheol , Na, Sang il , Choi, Jong Eun , Ahn, So Young; J Korean Acad Rehabil Med 2003;27(2):198-203.

Abstract
PDF

Objective
The aim of this study was to evaluate the bladder function in adults with cerebral palsy (CP).

Method: Thirteen adults with CP were participated in this study. Nine of these thirteen subjects had urological symptoms. The urological history taking, urine analysis, urine culture, voiding cystourethrography (VCUG) and urodynamic study were done.

Results: The urinary incontinence was the most common presenting symptom. All subjects without urological symptoms showed normal urodynamic findings. Eight of the subjects who had urological symptoms had abnormal findings on urodynamic study. All subjects showed normal findings on voiding cystourethrography. Based on urodynamic findings, six subjects were treated with anticholinergic drug and five (83.3%) of these subjects showed improvement of their urological symptoms.

Conclusion: Many adults with CP might have the problems in urination. Our study showed that many symptomatic subjects had abnormal urodynamic findings and much of these urological symptoms was improved with proper treatment. These adults with CP would, therefore, benefit from proper assessment and treatment, expecially in the subjects who have urological symptoms. (J Korean Acad Rehab Med 2003; 27: 198-203)

1,466 View
7 Download

The Clinical Usefulness of KCl Provocative Urodynamic Study in Spinal Cord Injured Patients with Neurogenic Bladder.: Shin, Ji Cheol , Park, Chang Il , Kim, Yong Rae , Seo, Cheong Hoon , Kim, Jung Eun , Lee, Byung Ho; J Korean Acad Rehabil Med 2000;24(5):908-916.

Abstract
PDF

Objective: The purpose of this study was to determine the clinical usefulness of KCl provocative urodynamic study in spinal cord injured patients with neurogenic bladder.

Method: Urodynamic studies using normal saline and 0.2 M KCl solution were performed on 46 spinal cord injured patients. The reflex volume was measured on urodynamic study using normal saline and 0.2 M KCl solution. If the reflex volume using KCl solution was smaller than 85% of reflex volume using normal saline, it was considered as positive response. Urine culture and urinalysis were also performed before urodynamic study.

Results: KCl provocative tests showed positive response in patients showing current infection on urine culture and urinalysis (p＜0.05). Comparing with the positive response group and negative response group, mean maximal bladder capacity was smaller and mean bladder compliance was lower in the positive response group (p＜0.05). No significant differences were found between positive and negative response groups according to age, duration since injury, completeness of injury, voiding methods, and anticholinergic medication. The mean reflex volume provoked by KCl solution was smaller and mean bladder compliance provoked by KCl solution was lower than those provoked by normal saline in the positive response group (p＜0.01).

Conclusion: The response of KCl provocative test suggested increased bladder-blood-urine barrier permeability by current urinary tract infection. We conclude that the KCl provocative urodynamic study is a useful method for detection of impaired bladder-blood-urine barrier in spinal cord injuries with neurogenic bladder.

1,519 View
10 Download

Usefulness of the Portable Cystometer.: Yoon, Seung Hyun , Oh, Hyung Suk , Lee, Il Yung , Rah, Ueon Woo , Moon, Hae Won , Jung, Do Young; J Korean Acad Rehabil Med 2000;24(3):463-468.

Abstract
PDF

Objective: To evaluate the usefulness of a newly devised portable cystometer to measure the pressure of bladder in a low cost and easier accessability.

Method: This study was performed in 47 patients with a conventional instrumental cystometer (Jupiter 8000, Wiest) and the newly devised portable cystometer. In the supine position, we measured the maximal intravesical pressure, abdominal pressure and bladder volume with the portable cystometer just after the measurement of the maximal detrusor pressure and bladder volume with the conventional instrumental cystometer. Paired t-test was utilized to analyze and compare the result.

Results: 1) There was no significant difference in the average maximal detrusor pressures measured by maximal intravesical pressures minus abdominal pressures, which were 38.32⁑20.97 cmH₂O by the conventional instrumental cystometer and 40.02⁑20.70 cmH₂O by the portable cystometer (p＞0.05). 2) There was no significant difference in the average bladder volumes at maximal detrusor pressure, which were 302.13⁑83.92 cc by the conventional instrumental cystometer and 314.04⁑94.17 cc by the portable cystometer (p＞0.05).

Conclusion: We conclude that there is no significant difference between the conventional instrumental cystometer and the portable cystometer in the measurement of detrusor pressure and bladder volume. We believe this portable cystometer would be a useful tool to evaluate the function of bladder in a low cost and easier accessability.

1,215 View
4 Download

Ice Water Urodynamic Study in Neurogenic Bladder of Spinal Cord Injured Patients.: Shin, Ji Cheol , Park, Chang Il , Bang, In Keol , Seo, Cheong Hoon , Kim, Yong Rae , Kim, Jung Eun; J Korean Acad Rehabil Med 2000;24(3):439-445.

Abstract
PDF

Objective: To determine the clinical utility of ice water test for the urodynamic study in neurogenic bladder of spinal cord injured patients.

Method: Warm water (20∼30^oC) urodynamic studies were performed on 66 spinal cord injured patients. Subsequently, ice water (4∼8^oC) urodynamic studies were performed. We determined the ice water test to be positive if the reflex volume of ice water urodynamic study is lower than the volume of the warm water urodynamic study.

Results: Ice water test was positive in 24 (55.8%) and negative in 19 (44.2%) of the 43 patients showing hyperreflexic detrusor activity in warm water urodynamic study. Ice water test was negative in all 23 cases showing areflexic detrusor activity. No significant difference was found between positive and negative ice water test groups for the level of injury, sex, age, extent of injury and duration since injury. If water was cool enough, positivity of ice water test was not affected by infusion rate. There was no difference between the two urodynamic studies of maximal bladder pressure and compliance.

Conclusion: This study suggests that ice water urodynamic study is a useful method for the evaluation of hyperreflexic neurogenic bladder activated by cold specific receptors via C afferent fibers in spinal cord injured patients.

1,494 View
20 Download

A Correlation of Bulbocavernosus Reflex Test and Urodynamic Investigation in the Spinal Cord Injury Patients.: Lee, Byung Woo , Cho, Yun Sang , Kim, Sang Han , Kwon, Hee Kyu , Lee, Hang Jae; J Korean Acad Rehabil Med 1998;22(4):848-852.

Abstract
PDF

Objective: To investigate the correlations of neurological level, BCR and urodynamic study (UDS) in the spinal cord injury(SCI) patients, we analyzed the results of BCR and UDS fundings.

Method: The sujects were twenty-four patients with SCI who were beyond 3 months following the SCI. According to the level of injury, the patients were divided into 3 groups: above T10 level, 7; T10 to L2 level, 8; below L2 level, 9. Electrophysiological BCR test and UDS were performed in all patients.

Results: The results showed a significant correlation between the BCR test and level of injury, however there was no correlation between the UDS and level of injury, nor between the detrusor function and BCR test. The results might be from a differential recovery of the somatic and autonomic nervous system.

Conclusion: As a part of comprehensive evaluation for the bladder function in the SCI patients, we recommend both the bulbocavernosus reflex test and urodynamic study. Further neurophysiological research would be needed to understand the urodynamic findings which did not correlate with the level of SCI.