An objective score to predict upper tract deterioration in spinal cord injury patients

Seo, Byung Wook; Kim, Chun Il; Lee, Sung Choon

Abstract

The primary objective in taking care of the spinal cord injury patients is preservation of renal function. We evaluated 28 cases with spinal cord injury, who underwent intravenous pyelography, voiding cystourethrography and urodynamic assessment to determine the effects of low bladder compliance, hyperreflexia and detrusor-sphincter dyssynergia on the upper tact during the past 5 years period. And also, an objective hostility score was introduced that would predict the fate of the upper tracts and help to determine the need of treatment. Urodynamic evaluation revealed that 17 or 28 cages (67 %) had detrusor hyperreflexia and 11 cases (33 %) had detrusor areflexia. Of the 28 cases. 12 cases (44 %) had low compliant bladder. Hydronephrosis was present in six of the 12 eases (41 %) that had low compliance. These results were in sharp contrast to the normal compliant bladder in which two of 16 cases (12 %) had hydronephrosis. No case with a hostility score of less than 5 went on to develop upper tract changes. In contrast, eight of 10 cases with scores of 6 or more went on to develop upper tract change. In conclusion, the patients with the hostility score of 6 or more were significantly at risk of developing upper tract damage. So, these patients should have adequate and frequent follow-up evaluation.