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Journal of the Korean Academy of Rehabilitation Medicine 1999;23(5):954-960.
A Follow-up of Neurogenic Bladder in Patients with Spinal Cord Injury.
Im, Min Sik , Lee, Bum Suk , Kim, Min Wook , Kim, Chang Won , Kim, Kee Kyung , Kim, Jae Hyung , Shin, Byung Soon
1National Rehabiltation Hospital.
2Department of Rehabilitation Medicine, Dae Joen St. Mary's Hospital.
척수손상으로 인한 신경인성 방광의 추적 관찰
임민식, 이범석, 김민욱, 김창원, 김기경, 김재형, 신병순1
국립재활병원 재활의학과 및 1대전 성모병원 재활의학과

The purposes of this study were 1) to evaluate the effectiveness of follow-up urologic evaluation of neurogenic bladder in patients with spinal cord injury, 2) to define risk factors causing upper urinary tract complications, and 3) to evaluate changes of the vesicoureteral reflux grade on follow-up study.

Urodynamic studys, ultrasonographys, and voiding cystourethrographys of 90 patients with spinal cord injury who admitted to the bladder clinic of National Rehabilitation Hostpital were evaluated. Of the 90 patients, twenty four patients (27%) had upper urinary tract complication (vesicoureteral reflux or hydronephrosis). The risk factors of upper urinary tract complication were compared. The patients who had vesicoureteral reflux were devided into two main groups: conservative medical treatment group (oxybutynin, atropine intravesical instillation and intermittent catheterization) and primary surgical treatment group, and then the changes of the vesicoureteral reflux grade on follow-up study were evlauated.

1) The incidence of upper urinary tract complication was 27% for all patients. After bladder clinic evaluation, the patients who were recommended the change of the voiding mothods were 24%, and 58% of the patients were need management to decrease maximal detrusor pressure.

2) Maximal bladder capacity by clinical voiding chart recording (≤250 ml), bladder wall deformity (≥trabeculation grade 2), leak point pressure (≥40 cmH20), and maximal detrusor pressure (≥90 cmH2O) were significantly different between patients with upper urinary tract complication and patients without that. 3) In the eight vesicoureteral reflux patients, five of six patients were cured or improved with conservative treatment and two patients were cured with surgical treatment.

The periodic follow-up evaluation of neurogenic bladder of spinal cord injured patients was important to prevent upper urinary tract deterioration. The factors related upper urinary tract complication were clinical bladder capacity, leak point pressure, bladder wall deformity (trabeculation) and maximal detrusor pressure.

Key Words: Neurogenic bladder, Urologic evaluation, Vesicoureteral reflux, Risk factors


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