Urodynamics of brain and spinal cord lesions by Krane-Siroky classification

Hong, Chang Dug; Park, Jae Shin

Abstract

The urodynamic study is a neurourologic diagnostic tool concerned with the identification and measurement or physiologic and pathologic factors involved in the storage, transportation. and evacuation of urine. However. sometimes there is poor correlation between the patient`s symptoms and the findings or urodynamic testing. as well as the misinterpretation of studies. Thus, we studied 40 patients who had voiding dysfunction after brain and spinal cord injuries, and compared the neurologic lesions with the urodynamic findings classified by Krane-Siroky. We have used simultaneous cystometry and sphincter EMG routinely and performed voiding cystourethrography (VCUG for evaluation of internal or external sphincter disorder specifically. In 9 cases of brain lesions. . cases showed detrusor hyperreflexia and 2 cases showed detrusor areflexia. Among the 7 cases of detrusor hyperreflexia, 5 cases showed coordinated sphincter and 2 cases showed striated sphincter dyssynergia. In 29 cases of suprasacral spinal lesions. 23 cases of detrusor hyperreflexia. and 1 cases showed detrusor areflexia. Among the 23 cases of detrusor hyperreflexia, 8 cases showed striated sphincter dyssynergia alone, and 2 cases showed both striated and smooth sphincter dyssynergia and these lesions were located in the high thoracic level. and 13 cases showed coordinated sphincter. In two cases of sacral lesions, all of these cases showed detrusor areflexia. Thus, a disparity between the neurologic lesion and urodynamic assessment was noted in 23 cases (57%) in terms of detrusor reflexia and sphincter coordination. These findings suggest that neurologic lesior does not always correlate with urodynamic finding in the patients with brain or spinal cord lesion And voiding cystourethrography would be a useful diagnostic procedure for evaluating internal or external sphincter action.