The Analysis of Risk Factors for Upper Urinary Tract Disease in Spinal Cord Injured Patients: Including Video Urodynamic Findings

Park, Jeong Su; Park, Won Hee

Abstract

PURPOSE: Upper urinary tract diseases are major factors increasing morbidity and mortality in patients with spinal cord injuries. A video urodynamic study is one of the best methods for detecting neuro-urologic functional impairment in such patients. Therefore, the risk factors of upper urinary tract diseases were evaluated in patients with a spinal cord injury undergoing video urodynamics.
MATERIALS AND METHODS
The subjects were 161 spinal cord injured patients with voiding difficulty. The patients were divided into 2 groups, on the basis of the presence of upper urinary tract diseases, and compared according to various objective factors. In addition, the neurogenic bladder dysfunction was classified according to the anatomical level of the spinal cord injury.
RESULTS
Of the 161 patients, 13 developed upper urinary tract diseases. When those patients with and without upper urinary tract diseases (complicated and normal groups, respectively) were compared, the rates of patients with chronic urethral or suprapubic catheterization, upper motor neuron injury, quadriplegia, complete injury and low compliance were higher in the complicated than the normal group. There was also an increasing rate of the prevalence of detrusor areflexia in lower motor neuron lesions. The patients with detrusor hyperreflexia, accompanied by detrusor-sphincter dyssynergia, mostly had a cervical cord injury.
CONCLUSIONS
Chronic urethral or suprapubic catheterization, upper motor neuron injury, complete injury with quadriplegia, and low compliance are thought to be risk factors for inducing upper tract diseases in spinal cord injury patients. Thus, patients exposed to these factors should be monitored through video urodynamics and radiologic evaluation for the prevention and early detection of upper urinary tract diseases.