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

Abstract

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.